本文選題：妊娠期肝內(nèi)膽汁淤積癥 + 新生兒高膽紅素血癥�。� 參考：《遵義醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的： 了解妊娠期肝內(nèi)膽汁淤積癥（intrahepatic cholestasis of pregnancy,ICP)的發(fā)病情況及其圍產(chǎn)兒結(jié)局，探討母親患有ICP與其新生兒發(fā)生早期新生兒高膽紅素血癥發(fā)病率的相關(guān)性。 方法： 選取2012年10月至2013年10月于遵義醫(yī)學(xué)院附屬醫(yī)院住院分娩的ICP患者及其分娩的新生兒各57例為觀察組，正常孕產(chǎn)婦及其分娩新生兒各161例為對(duì)照組，記錄所有孕產(chǎn)婦的年齡、孕周、孕產(chǎn)次、分娩方式，及新生兒體重、喂養(yǎng)方式、早產(chǎn)、胎膜早破、窒息或?qū)m內(nèi)窘迫、羊水糞染及羊水量情況，經(jīng)皮黃疸儀動(dòng)態(tài)監(jiān)測(cè)出生7日內(nèi)新生兒膽紅素情況，并予末梢血微量測(cè)定法進(jìn)行間斷復(fù)核。 結(jié)果： （1）ICP組與對(duì)照組婦女在年齡、分娩孕周、孕次及產(chǎn)次比較無(wú)差異（P＞0.05）； （2）ICP婦女血清總膽汁酸（total bile acid，TBA）、總膽紅素（total Bilirubin，TBIL）、直接膽紅素（direct bilirubin，DBIL）、丙氨酸氨基轉(zhuǎn)移酶（alanine aminotransferase，ALT）、門(mén)冬氨酸氨基轉(zhuǎn)移酶（aspartate aminotransferase，AST）水平明顯高于對(duì)照組,差異具有顯著性（P＜0.05）；（3）ICP組剖宮產(chǎn)、羊水糞染、新生兒窒息、早產(chǎn)及圍產(chǎn)兒死亡發(fā)生率分別為78.59%、22.81%、17.54%、26.32%、8.78%，對(duì)照組分別為56.62%、8.07%、5.64%、4.35%、0.62%，兩組比較均具有顯著性差異（P＜0.05），出生體重、發(fā)病時(shí)間及胎膜早破發(fā)生率比較均無(wú)明顯差異（P＞0.05）；（4）ICP組早期新生兒高膽紅素血癥發(fā)病率35.10%，對(duì)照組10.56%，ICP組較對(duì)照組明顯高（P＜0.05）；ICP組早產(chǎn)兒較足月兒高膽紅素血癥發(fā)病率高（P＜0.05）；（5）ICP組剖宮產(chǎn)分娩新生兒發(fā)生早期高膽紅素血癥發(fā)病率40.00%，，自然分娩新生兒高膽發(fā)病率16.67%，ICP時(shí)自然分娩新生兒高膽發(fā)病率較剖宮產(chǎn)兒發(fā)病率低，具有顯著性差異（P＜0.05）；（6）ICP組新生兒高膽紅素血癥發(fā)病率與母親血清TBA、TBIL、DBIL水平呈正相關(guān)（P＜0.05），相關(guān)系數(shù)分別為0.384、0.301、0.308。 結(jié)論： 1、ICP患者分娩的新生兒早期新生兒高膽紅素血癥發(fā)病率高。 2、高濃度膽汁酸、膽紅素水平及其所致早產(chǎn)、剖宮產(chǎn)及胎兒宮內(nèi)缺氧等，可能與ICP的新生兒發(fā)生早期高膽紅素血癥有關(guān)。
[Abstract]:Objective: To investigate the incidence and perinatal outcome of intrahepatic cholestasis of precancerous cholestasis of pregnancy, and to explore the relationship between maternal ICP and the incidence of early neonatal hyperbilirubinemia. Methods: From October 2012 to October 2013, 57 ICP patients and 57 newborns delivered in the affiliated Hospital of Zunyi Medical College were selected as observation group and 161 normal pregnant women and their newborn babies as control group. The age of all pregnant women was recorded. Gestational week, time of delivery, mode of delivery, weight of newborn, feeding mode, preterm delivery, premature rupture of membranes, asphyxia or intrauterine distress, feces staining of amniotic fluid and amniotic fluid volume, dynamic monitoring of neonatal bilirubin within 7 days of birth by percutaneous jaundice instrument. The method of microdetermination of peripheral blood was used for intermittent reexamination. Results: There was no significant difference between ICP group and control group in age, gestational age, pregnancy and delivery (P > 0.05). The serum total bile acid (TBA), total bilirubin (TBI), direct bilirubin (DBIL), alanine aminotransferase (Ala), aspartate aminotransferase (AST) in the ICP group were significantly higher than those in the control group (P < 0.05). The incidence of neonatal asphyxia, premature delivery and perinatal death were 78.59, 22.81 and 17.54, 26.32 and 8.78, respectively, and those in the control group were 56.62 and 8.07, respectively. There was significant difference between the two groups (P < 0.05, birth weight). There was no significant difference in the incidence of premature rupture of membranes and the incidence of premature rupture of membranes (P > 0.05). The incidence of early neonatal hyperbilirubinemia was 35.1010 in the ICP group, and significantly higher in the ICP group than that in the control group (P < 0.05); the incidence of hyperbilirubinemia in the ICP group was significantly higher than that in the term group (P < 0.05); the incidence of hyperbilirubinemia in the ICP group was significantly higher than that in the control group (P < 0.05). The incidence of early hyperbilirubinemia in newborns born by cesarean section was 40.00.The incidence of hyperbilirubinemia in newborns with spontaneous delivery was 16.67. The incidence of hyperbilirubinemia in newborns born naturally during ICP was lower than that in infants born by cesarean section. The incidence of neonatal hyperbilirubinemia was positively correlated with the maternal serum TBABILL DBIL level (P < 0.05), and the correlation coefficients were 0.3840.301 and 0.308, respectively. Conclusion: 1the incidence of early neonatal hyperbilirubinemia in ICP patients was high. 2, high concentration of bile acid, bilirubin and preterm labor, cesarean section and fetal intrauterine hypoxia may be associated with early hyperbilirubinemia in neonates with ICP.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R714.7

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