高原地区不同民族新生儿红细胞增多症临床研究

目的 分析高海拔地区新生儿缺氧与红细胞增多症的关系,对高原世居藏族新生儿与移居高原汉族新生儿临床特点进行研究.方法 2005年1月1日至2006年10月31日,我院新生儿病房收治的739例患儿.对其中资料完整符合新生儿红细胞增多症者40例(其中藏族20例,汉族20例)进行了临床特点、检测经皮氧饱和度( TcSP02)、末梢血常规[血红蛋白(Hb)、红细胞(RBC)、红细胞压积(HCT)]和心肌酶谱研究分析.结果 汉族新生儿Hb为26.72±3.25、HCT为0.684±0.051、RBC为7.63±1.98三项值明显高于藏族新生儿的24.89±1.76、HCT 0.678±0.045、6.89±1.72,P≤0.05.汉族新生儿红细胞增多症者TcSP02浓度较藏族新生儿低82±5.882,P≤0.05,差异有统计学意义;汉族新生儿红细胞增多症患者末梢血常规血红蛋白(Hb)、红细胞( RBC)、红细胞压积(HCT)水平高于藏族新生儿,P≤0.05,藏族新生儿红细胞增多症末梢血常规血Hb、RBC、HCT治疗后均降至正常水平;心肌酶谱检测结果汉族组肌酸激酶同工酶( CKMB)治疗前与藏族组比较,F=171.41、P＜0.01,肌钙蛋白汉族组治疗前与藏族组比较,F=2.31、P＞0.01.肌红蛋白汉族组治疗前与藏族组比较,差异有统计学意义F=60.06、P＜0.01.藏汉族两组共同临床特征:呼吸急促,发绀、多血质外貌,易激惹、反射弱、低氧血症为主.缺氧为诱发因素;汉族组临床除以上共同特征外、以反应差、呼吸暂停、肌张力低下、神志淡漠、窒息为主要特征.40例新生儿红细胞增多症以低氧血症和心肌受损为主要表现.结论 高原新生儿红细胞增多症临床特征、TcSP02、末梢血常规和心肌酶谱变化特征对于指导新生儿红细胞增多症诊断治疗有一定的临床意义.移居高原者在高海拔地区更易发生新生儿红细胞增多症,且易导致其他器官,尤其是心脑功能受损.

Clinical characteristics and changes in blood electrolyte and renal function of neonates with polycythemia at high altitude

Objective To analyze the relationship between neonatal hypoxia and polycythemia and to study clinical characteristics of Tibetan neonates whose family lived in Tibetan plateau for generations and Han neonates whose family moved to the plateau.Method From Jan.2005 to Oct.2006,totally 739patients were hospitalized in the ward of neonatology of the hospital.Of these patients,40 (20 were Tibetan and the other 20 were Han ) with neonatal polycythemia.The clinical features,transcutaneous oxygen saturation (TcSO2 ),peripheral routine tests and myocardial enzyme profile were studied.Result The values of hemoglobin (Hb),hematocrit (HCT),and erythrocyte count (RBC) of the Han neonates were significantly higher than those of the Tibetan newborns.Han neonates with polycythemia had lower TcSPO2 than Tibetan neonates (P ＜0.01 ).Comparison of myocardial enzymes showed that Han neonates had higher CKMB than that of Tibetan groups before treatment ( P ＜ 0.01 ),troponin was not significantly different between the Han and Tibetan groups before treatment ( P ＞ 0.05 ).The major common clinical manifestations of the Han and Tibetan newborns were tachypnea,cyanosis,irritability,weak reflexes and hypoxemia.The Han neonates additionally had poor responses,apnea,lower muscle tone,confusion and asphyxia.Conclusion The clinical characteristics,TcS02,peripheral blood routine tests and myocardial enzyme profile are helpful in diagnosis and treatment of neonatal polycythemia.Newborn infants born to mothers who moved to the plateau area may be more susceptible to neonatal polycythemia and are prone to impairments of other organs,esp.the functions of the heart and brain.