摘要
目的 分析新生儿高胆红素血症影响因素与中医证型的分布规律,为中西医结合防治新生儿高胆红素血症提供临床依据。方法 收集2020年1月-2020年12月北京市朝阳区妇幼保健院收治的348例新生儿高胆红素血症患者临床资料,进行回顾性分析,收集患儿性别、胎龄、体质量、黄疸出现时间、分娩方式、总胆红素值等信息。结果 348例新生儿高胆红素血症患儿的中医辨证分型,其中湿热郁蒸证117例(33.6%),寒湿阻滞证111例(31.9%),气滞血瘀120例(34.5%)。中医证型与胎龄:湿热郁蒸证足月儿比例为54.7%(64/117),高于其他两型,寒湿阻滞证足月儿比例55.9%(62/111),高于其他两型;气滞血瘀证型中早产儿比例46.7%(56/120),明显高于其他两型,具统计学意义(P<0.05)。早产儿以气滞血瘀证为主(53.8%,56/104),足月儿以湿热郁蒸证(42.4%,64/151)、寒湿阻滞证为主(41.1%,62/151)。过期儿中以气滞血瘀证为主(41.9%,49/117)。中医证型与性别:中医证型与性别无明显差异,无统计学意义(χ^(2)=5.988,P>0.05)。中医证型与黄疸出现时间:7 d内出现黄疸者可见于各个证型,无统计学意义,7 d以上出现黄疸以气滞血瘀证为主,湿热郁蒸证以3 d内多见,占48.7%(57/117);寒湿阻滞证以3天内多见,占52.3%(58/111);气滞血瘀证可见于各个时间段。中医证型与出生体质量:低出生体质量儿以气滞血瘀证为主(46.5%,40/86);适于胎龄儿湿热郁蒸证、寒湿阻滞证、气滞血瘀证所占比例分别为36.4%(68/187)、34.2%(64/187)、29.4%(55/187),可见于各个证型,差异无统计学意义;巨大儿湿热郁蒸证、寒湿阻滞证、气滞血瘀证所占比例分别为34.7%、32%、33.3%,可见于各个证型,差异无统计学意义。湿热郁蒸多见于适于胎龄儿,58.1%(68/117),寒湿阻滞多见于适于胎龄儿(45.8%,55/120),低出生体质量儿(33.3%,40/120)。中医证型与分娩方式:剖宫产出生者中医证型的分布与顺产患儿分布对比,差异无统计学意义(P>0.05)。中医证型与胆红素水平:各证型与各胆红素水平之间均无统计学意义(P<0.05);胆红素值在≤250μmol/L患儿大多为气滞血瘀证(36.6%,59/161);胆红素值在250~342μmol/L患儿大多为湿热郁蒸证(37.7%,40/106);胆红素值>342μmol/L,中医证型分布对比,无统计学意义(P>0.05);湿热郁蒸证多见于胆红素值在≤250μmol/L患儿;寒湿阻滞证多见于≤250μmol/L患儿;气滞血瘀证多见于≤250μmol/L患儿。结论 新生儿高胆红素血症中医证型与胎龄、出生体质量、胆红素水平有一定的分布规律。
Objective To analyze the influencing factors of neonatal hyperbilirubinemia and the distribution regularity of TCM syndromes and provide the clinical basis for the combination of traditional Chinese and Western medicine in the treatment of neonatal jaundice.Methods The clinical data of 348 cases of neonatal pathological jaundice in Beijing Chaoyang Maternal and Child Health Hospital from January 2020 to December 2020 were collected and analyzed retrospectively.The information of gender,gestational age,weight,jaundice occurrence time,mode of delivery and total bilirubin value was collected.Results There were 117 cases(33.6%)of damp-heat stagnation syndrome,111 cases(31.9%)of cold-damp block syndrome and 120 cases(34.5%)of Qi stagnation and blood stasis syndrome.TCM syndrome types and gestational age:The proportion of full-term infants with damp-heat stagnation syndrome was 54.7%(64/117),which was higher than that of the other two types;the proportion of full-term infants with cold-damp block syndrome was 55.9%(62/111),which was higher than that of the other two types;the proportion of premature infants with Qi stagnation and blood stasis syndrome was 46.7%(56/120),which was significantly higher than that of the other two types,with statistical significance(P<0.05).Premature infants were mainly Qi stagnation and blood stasis syndrome(53.8%)and the full-term infants were mainly damp-heat stagnation syndrome(42.4%)and cold-damp block syndrome(41.1%).The main type of overdue infants was Qi stagnation and blood stasis syndrome(41.9%,49/117).TCM syndrome types and gender:There was no significant difference between TCM syndrome types and genders(χ^(2)=5.988,P>0.05).TCM syndrome types and jaundice occurrence time:The jaundice within 7 days can be seen in each syndrome type,without statistical significance.The jaundice more than 7 days was mainly Qi stagnation and blood stasis syndrome,damp-heat stagnation syndrome was more common within 3 days,accounting for 48.7%;cold-damp block syndrome was more common within 3 days,accounting for 52.3%;Qi stagnation and blood stasis syndrome can be seen in each time period.TCM syndrome types and birth weight:The low birth weight infants mainly had Qi stagnation and blood stasis syndrome(46.5%);the gestational age infants with damp-heat stagnation syndrome,cold-damp block syndrome and Qi stagnation and blood stasis syndrome accounted for 36.4%,34.2%and 29.4%,respectively,which could be seen in each syndrome type,and the difference was not statistically significant.The giant infants with damp-heat stagnation syndrome,cold-damp block syndrome and Qi stagnation and blood stasis syndrome accounted for 34.7%,32%and 33.3%,respectively.The difference was not statistically significant.Damp-heat stagnation syndrome was more common in gestational age infants(58.1%,68/117).Cold-damp block syndrome was more common in gestational age infants(45.8%,55/120)and low birth weight infants(33.3%).TCM syndrome types and mode of delivery:There was no significant difference between the distribution of TCM syndrome types of cesarean section and that of spontaneous delivery(P>0.05).TCM syndrome types and bilirubin level:There was no statistical significance between each syndrome type and bilirubin level(P<0.05);most of the children with bilirubin value≤250μmol/L were Qi stagnation and blood stasis syndrome(36.6%);most of the children with bilirubin value between 250-342μmol/L were damp-heat stagnation syndrome(37.7%);bilirubin value>342μmol/L were Qi stagnation and blood stasis syndrome(36.6%).There was no statistical significance in the distribution of TCM syndromes(P>0.05).Damp-heat stagnation syndrome was more common in children with bilirubin value≤250μmol/L;cold-damp block syndrome was more common in children with bilirubin value≤250μmol/L;Qi stagnation and blood stasis syndrome was more common in children with bilirubin value≤250μmol/L.Conclusion TCM syndrome types of neonatal jaundice are related to gestational age,birth weight and bilirubin level,but not related to the genders and the mode of delivery.
作者
秦胜娟
佘继林
QIN Shengjuan;SHE Jilin(Chaoyang District Women and Children Health Care Hospital,Beijing 100026,China;Beijing Traditional Chinese Medicine Hospital,Beijing 100021,China)
出处
《辽宁中医杂志》
CAS
2023年第5期104-107,共4页
Liaoning Journal of Traditional Chinese Medicine
基金
北京市中医药“薪火传承3+3”工程(2017-SZ-C-68)。
作者简介
秦胜娟(1985-),女,河南安阳人,主治医师,硕士,研究方向:中医治疗儿科相关疾病;通讯作者:佘继林(1948-),男(回族),北京人,主任医师,研究方向:中医儿童疾病的诊治。
