Objective To observe the change of serum TBiL level of newborns,to explore its clinical significance. Methods A total of 232 newborns with neonatal asphyxia were selected in Maternity and Child Care Center of Hengshui from March 2011 to December 2013,and they were divided into A group〔with mild asphexia(Apgar score at 4 to 7)〕and B group〔with severe asphexia(Apgar score at 0 to 3)〕according to Apgar score,each of 116 cases. A total of 120 healthy newborns were selected as control group. Serum TBiL level after 2 days,5 days,7 days and 10 days of birth,serum AST,LDH,CK,α-HBDH levels after 2 days and 7 days of birth were compared among the three groups,and correlation between serum TBiL level and Apgar score was analyzed. Results After 2 days and 10 days of birth,serum TBiL level of B group was statistically significantly higher than that of control group and A group,respectively,while after 5 days and 7 days of birth,serum TBiL level of B group was statistically significantly lower than that of control group and A group,respectively(P<0. 05). Within 7 days after birth,serum TBiL level of the three groups showed increasing trend,but the climb rate of control group and A group was statistically significantly higher than that of B group,respectively;after 7 days of birth,serum TBiL level of the three groups showed decreasing trend,the descent rate of control group and A group was also statistically significantly higher than that of B group,respectively. After 2 days and 7 days of birth,serum AST,LDH,CK,α-HBDH levels of A group were statistically significantly higher than those of control group,and serum AST,LDH,CK,α -HBDH levels of B group were statistically significantly higher than those of A group and control group(P<0. 05). Pearson correlation analysis showed that,serum TBiL level after 2 days of birth was negatively correlated with Apgar score(r2 =0. 430,r= -0. 656,P=0. 000),serum TBiL level after 5 days of birth was positively correlated with Apgar score(r2 =0. 543,r=0. 737,P=0. 000),serum TBiL level after 7 days of birth was negatively correlated with Apgar score(r2 =0. 512,r=0. 715,P=0. 000),serum TBiL level after 10 days of birth was negatively correlated with Apgar score(r2 =0. 291,r = -0. 539,P =0. 000). Conclusion Within 10 days after birth,serum TBiL level of newborns shows firstly increased and afterwards decreased trend,and it is negatively correlated with Apgar score on the second and tenth day after birth,is positively correlated with Apgar score on the fifth and seventh day after birth;the more severe of neonatal asphyxia,the more slow of change rate of serum TBiL level.%目的：探讨新生儿窒息患儿总胆红素水平（ TBiL）变化及其临床意义。方法选取2011年3月—2013年12月衡水市妇幼保健院收治的新生儿窒息患儿232例，根据患儿Apgar评分分为轻度窒息（ Apgar评分4~7分）患儿116例（轻度窒息组）和重度窒息患儿（ Apgar评分0~3分）116例（重度窒息组）。另选取同期在衡水市妇幼保健院出生的各方面指标均正常的新生儿120例作为对照组。比较3组新生儿出生后第2天、第5天、第7天、第10天血清TBiL水平及出生后第2天、第7天心肌酶指标〔血清天门冬氨酸氨基转移酶（ AST）、乳酸脱氢酶（ LDH）、肌酸激酶（ CK）、α-羟丁酸脱氢酶（α-HBDH）水平〕，并分析血清TBiL水平与Apgar评分的关系。结果出生后第2天和第10天重度窒息组患儿血清TBiL水平高于对照组和轻度窒息组，出生后第5天和第7天血清TBiL水平低于对照组和轻度窒息组（ P<0.05）。出生后7 d内，3组新生儿血清TBiL水平均呈升高趋势，但对照组与轻度窒息组升高速度快于重度窒息组；第7天达到峰值后，3组新生儿血清TBiL水平呈下降趋势，对照组与轻度窒息组下降速度快于重度窒息组。轻度窒息组患儿出生后第2天、第7天血清LDH、CK、α-HBDH水平高于对照组，重度窒息组患儿出生后第2天、第7天血清AST、LDH、CK、α-HBDH水平高于对照组和轻度窒息组（ P<0.05）。Pearson相关分析结果显示，出生后第2天血清TBiL水平与Apgar评分呈负相关（r2=0.430，r=-0.656，P=0.000），出生后第5天血清TBiL水平与Apgar评分呈正相关（r2=0.543，r=0.737，P=0.000），出生后第7天，血清TBiL水平与Apgar评分呈正相关（r2=0.512，r=0.715，P =0.000），出生后第10天血清 TBiL 水平与 Apgar 评分呈负相关（r2=0.291，r =-0.539，P=0.000）。结论新生儿出生后10 d内血清TBiL水平呈先上升后下降趋势，且出生后第2天和第10天血清TBiL水平与Apgar评分呈负相关，出生后第5天和第7天血清TBiL水平与Apgar评分呈正相关，新生儿窒息程度较重患儿血清TBiL水平变化较缓慢。
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