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新生儿黄疸究竟是什么?黄疸的产出是怎么回事?

发布日期:2022-06-06 16:00:43编辑:佚名

医生给新生儿开茵栀黄口服液,月嫂该怎么办?

象妈妈母婴生活07-07 11:12

在江浙一带,如果新生儿出现黄疸偏高现象,不少医院的医生会开茵栀黄口服液进行退黄处理。有些月嫂根据自己的实践经验或是从网上得知茵栀黄会带来一些副作用,比如腹泻并发红臀、小儿哭闹等,在这种情况下,月嫂该怎么办呢?

其实,这涉及两个概念性问题:一、黄疸究竟是什么?二、茵栀黄的副作用究竟大不大?下面象妈妈来仔细聊聊这个问题。

黄疸究竟是什么?

“黄疸的产出是由于婴儿血液中一种叫‘胆红素’的化学物质累积而引起的,而新生儿肝脏发育不够成熟,不足以完成清除血液循环中胆红素的功能。”——美国儿科学会育儿百科“黄疸”词条。

胎儿个个都像“藏族人”

儿科专家崔玉涛对黄疸的形成有一种让人比较容易理解的解读:“出生前,胎儿生长于妈妈子宫内,相对于大气来说是低氧环境。与高原生活的人们一样,会出现红细胞增多现象,以增加血液携氧量。出生后,婴儿开始通过肺与大气形成气体交换。氧气增多,大量红细胞变多余,体内衰变形成引起黄疸的物质——黄色的胆红素。因此皮肤变黄。” 按“崔神”的解读黄疸入脑的几率大吗,胎儿个个都像藏族人或是夏尔巴人一样,有明显多于常人的红细胞。

黄疸是病吗?

对大部分出现黄疸的新生儿而言,这是可以自愈的功能性疾病,其产生的根源在于不成熟的肝脏发育。

象妈妈母婴护理顾问崔钢认为,新生儿离开母体第一时间是肺扩张,产生呼吸。随着哺乳开始,胃肠液体分泌,肠道菌群渐渐产生平衡。产后三天,新生儿自身血液循环完成,肝脏开始造血,母体带来前三天帮助运氧的血红细胞,随即迅速破坏,其中的胆红素大量堆积,新生儿肝酶缺乏,来不及转运,于是这许多胆红素渗入皮肤巩膜,形成黄疸,每个宝宝出生都是这么一个过程,所以就称之为:生理性黄疸。她认为生理性黄疸的宝宝属于健康宝宝。

但是,也有例外。如果孩子在出生后24小时内就出现黄疸或黄疸发展过快,持续时间较长,甚至伴有贫血、体温不正常、吃奶不好、呕吐、大小便颜色异常,有的是黄疸已经消退或减轻后又重新出现和加重,按国内对黄疸的划分,算作病理性黄疸。病理性黄疸常见的原因是新生儿溶血病、新生儿感染、胆道畸形和新生儿肝炎等。 此外,作为月嫂,如果发现孩子的黄疸开始过膝过肘,必须马上抱送医院,确定是否为病理性黄疸。

母乳性黄疸又是什么鬼?

崔钢表示,其实母乳性黄疸是生理性黄疸的延续,主要是因为宝宝肝酶未发育全,胆红素的运转是要肝脏转换酶分解转换的,但是母乳蛋白也是妈妈体内类于胆红素结构的物质,也需要酶分解转换,新生儿肝酶单一同时数量不多,会先尽着母乳蛋白吸收,胆红素就得空下来再运,也因为奶粉不用肝酶分解吸收蛋白质,所以有空闲的酶运转胆红素,这就是母乳性黄疸时间较长的缘故。

胆红素入脑有多可怕?

黄疸非常严重时,最可怕的是胆红素脑病。胆红素进入脑部,与神经细胞结合后破坏神经,并把脑组织染黄。皮肤黄疸还能消退,但脑神经一旦被染黄就会坏掉,永远无法修复。胆红素对神经的伤害可造成智力低下、瘫痪、耳聋等,并且无法恢复。一旦胆红素入脑,抢救以小时或分钟计。

虽然出现的概率极低,但正是因为胆红素入脑的可怕且不可逆,因此,在处理黄疸稍高时,医生往往会采用“宁可错杀一千,不可放过一个”的过度治疗策略,中国的国情嘛,你懂的。

茵栀黄到底是干嘛的?

茵栀黄是中国的一种传统治疗黄疸的中药合剂,主要用于病理性肝炎的退黄治疗。其主要成分是茵陈、栀子、大黄(或黄芩)金银花提取物。

几乎所有的“茵栀黄”自己的药品说明书上都没注明可以治疗新生儿黄疸。只有被“潜规则”过的百度词条“茵栀黄”的“现代应用”一栏下,有“用于治疗新生儿高胆红素血症;急、慢性肝炎。”

茵栀黄究竟有多少副作用?

我们查阅了多家茵栀黄口服液的药品说明书,在“不良反应”、“药品禁忌”都只有四个字: 尚不明确。

我们对上海市儿童医学中心、儿童医院的新生儿科部分儿科医生进行了采访(姓名谨遵医嘱:保密),得到的回复一致:“茵栀黄是中成药,副作用不大,没关系的。”

但 原北京中医药大学附属中西医结合医院儿科主任张思莱表示:“虽然有一些中西医结合医生做过光疗和中药联合治疗新生儿高胆红素血症有关方面的研究,但是没有更多的循证依据证明究竟是光疗起了主导作用,还是口服中药制剂退黄起的作用。新生儿和小婴儿吃了茵栀黄制剂不但可能会影响消化道功能,出现恶心、呕吐、腹泻都是常见的不良反应,而且还促使肠道微生态平衡失调。”她认为 “不良反应还不明确的药物”怎么能给发育稚嫩的新生儿吃呢。

象妈妈母婴护理顾问崔钢也持相同观点,她认为对生理性黄疸宝宝,不应该随意用药,试想一下,成人的饭你敢给新生儿吃吗?吃茵栀黄的宝宝都会拉绿便,宝宝肠蠕动加快,突然大哭,说不出来,那是腹痛难忍。

晒太阳退黄疸靠谱吗?

目前,学术界对通过晒太阳的方式减轻黄疸也存在一些分歧。不少新生儿科医生认为:目前并没有科学实验证据表明这是一种成熟的解决方案,而更多的是一种推测。太阳光虽然含有蓝光,含量却有限,自家开窗子晒黄疸跟感冒多喝水一样黄疸入脑的几率大吗,是一个友善但未必有明显效果的建议。

崔玉涛认为,紫外线A可以穿透玻璃,照在皮肤上,可以帮助新生儿消退黄疸。

象妈妈母婴护理顾问崔钢,根据她四十年的临床实践经验表明表示,自然光对退黄疸是有效的,只要保护好眼睛。她认为,肝酶运转不够的母乳性黄疸不用刻意治疗,只要监控黄疸指数在正常范围就行,多照自然光,待一两个月后肝脏发育完善点,“运输车”多了,就会突然退黄。

面对黄疸新生儿,月嫂能做点啥?

说到这里,大多数月嫂肯定都懵圈了,医生们对茵栀黄的退黄作用以及太阳光、自然光退黄产生了学术上的分歧,那作为月嫂究竟该怎么办呢?

其实, 新生儿黄疸形成三大主要原因是: 生成较多,代谢较慢,排出较少。治疗黄疸釜底抽薪的治疗方法是 加快代谢(让新生儿腹泻,是茵栀黄的治疗手段还是副作用?我可以傻傻分不清吗?)简单说来,就是“ 多吃多拉,有助退黄”。

我们对象妈妈旗下五十多位超过十年以上护理经验的月嫂进行过面试, 发现其中最优秀的一批月嫂都遵循“母乳喂养,多吃多拉,加速代谢”的原则对生理性黄疸进行退黄,据她们表示效果均非常显著。

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