【摘要】：目的:探討光療前后前胸(遮蓋及未遮蓋)、眉心、肩胛部位經(jīng)皮膽紅素(TcB)值,與同時(shí)測(cè)定的血清膽紅素(TSB)值比較,分析其準(zhǔn)確性。運(yùn)用經(jīng)皮膽紅素水平評(píng)價(jià)茵梔黃口服液對(duì)新生兒(尤其是早產(chǎn)兒)高膽紅素血癥的療效及安全性。方法:選自2015年9月至2016年7月入住我院新生兒科的新生兒。1.符合入選標(biāo)準(zhǔn)后檢查TSB,并在0.5h內(nèi)采用JH20-1C型經(jīng)皮黃疸儀測(cè)定前胸、眉心、肩胛部位的TcB(364例,437組數(shù)據(jù))。新生兒光療停止后Oh(193例)、12 h-24h(175例)測(cè)定TSB值,并在0.5 h內(nèi)測(cè)定左胸遮蓋、右胸、眉心、肩胛部位的TcB。2.將胎齡≥32周且出生體重≥1500g的新生兒高膽紅素血癥患兒用隨機(jī)數(shù)字法隨機(jī)分為兩組:單純光療組(光療組,67例),僅給予光療治療;光療聯(lián)合茵梔黃組(聯(lián)合組,69例),給予光療及茵梔黃口服液2ml/(kg.次),每12 h一次,連服5天。每12 h監(jiān)測(cè)一次胸骨左緣貼片遮蓋下的經(jīng)皮膽紅素(TcB)水平。記錄兩組患兒一般資料、入組第0h、第60 h和入組第120 h TcB水平、入組120 h內(nèi)總計(jì)光療時(shí)間、再光療率、皮疹及腹瀉等不良反應(yīng)發(fā)生率。采用SPSS 20.0軟件,選用相關(guān)分析、方差分析、一致性分析、t檢驗(yàn)、卡方檢驗(yàn)、重復(fù)測(cè)量數(shù)據(jù)的方差分析、積矩相關(guān)性分析。結(jié)果:1.光療前,不同部位TcB與TSB均有較高的相關(guān)性及一致性(均P0.05),前胸TcB相對(duì)最佳、與TSB差值相對(duì)最小。光療停止后0 h及12-24 h,TSB與左胸遮蓋TcB差值最小(-1.2±2.3mg/dl、-0.5±1.6mg/dl),相關(guān)性及一致性均最佳。光療前當(dāng)TSB≥15mg/dl時(shí),(TSB-前胸 TcB)差值 1.5±1.6mg/dl;當(dāng) TSB15mg/dl 時(shí),(TSB-前胸 TcB)差值-1.9±1.9mg/dl,差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。(TSB-前胸TcB)差值不受性別、胎齡、出生體重、測(cè)定時(shí)齡及重復(fù)測(cè)量影響。當(dāng)前胸或左胸遮蓋部位TcB值低于光療或停光療TSB閾值大于3.3 mg/dl或2.6 mg/dl時(shí),假陰性率小于2.5%;當(dāng)前胸或左胸遮蓋部位TcB值低于光療或停光療TSB閾值大于4.2 mg/dl或3.2 mg/dl時(shí),假陰性率小于1%。2.光療組和聯(lián)合組之間入組第60 h TcB水平相似(P0.05),聯(lián)合組入組第120 h TcB水平低于光療組,差異有統(tǒng)計(jì)學(xué)意義(9.4±1.1mg/dl對(duì)9.8±1.4mg/dl,P0.045)。聯(lián)合組TcB水平下降程度大于光療組。聯(lián)合組與光療組入組120h內(nèi)總計(jì)光療時(shí)間(70.1±13.0h對(duì)72.0±13.4 h)、再光療率(31.9%對(duì)34.3%)、皮疹發(fā)生率(10.1%對(duì)9.0%)差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。聯(lián)合組腹瀉發(fā)生率(21.7%)明顯高于光療組(11.9%),但差異尚無統(tǒng)計(jì)學(xué)意義(P=0.127)。聯(lián)合組入組120 h內(nèi)大便總次數(shù)與入組第120 h TcB水平下降值呈顯著線性正相關(guān)關(guān)系(r=0.75,P=0.000)。聯(lián)合組中早產(chǎn)兒亞組(41例)在入組第60h、第120hTcB水平下降率(14.0±13.1%、24.3±12.7%)均低于足月兒亞組(28 例)(26.9±13.4%、35.4±11.7%),差異均有統(tǒng)計(jì)學(xué)意義(P=0.000、0.000)。早產(chǎn)兒亞組與足月兒亞組入組120 h內(nèi)總計(jì)光療時(shí)間(72.3±14.8h 對(duì) 66.9±8.9h)、再光療率(34.1%對(duì) 28.6%)、皮疹(9.8%對(duì) 10.7%)及腹瀉發(fā)生率(24.4%對(duì)17.9%)的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.光療前,前胸TcB相對(duì)最準(zhǔn)確;光療后,左胸遮蓋TcB最準(zhǔn)確,能替代TSB用于新生兒黃疸的評(píng)估與管理。2.茵梔黃在輔助光療治療新生兒高膽紅素血癥方面有一定療效,但起效相對(duì)較慢,作用相對(duì)較弱,僅能作為一種輔助療法。不良反應(yīng)主要是大便次數(shù)稍有增多。大便次數(shù)與療效呈正相關(guān)。茵梔黃口服液可以一樣安全有效地用于輔助光療治療足月兒及早產(chǎn)兒高膽紅素血癥,但用于早產(chǎn)兒療效略低于足月兒。
[Abstract]:Objective: To investigate the value of the anterior chest (covering and uncovered) before and after phototherapy, the value of the skin bilirubin (TcB) of the eyebrows and the scapula, compared with the value of the serum bilirubin (TSB) measured at the same time, and analyze its accuracy. The effect and safety of the peric bilirubin level on the hyperbilirubinemia of the newborns (especially preterm infants) were evaluated by the percutaneous bilirubin level. Method: 2 The newborn.1. from September to July 2016 of 015 years was checked with TSB, and the TcB (364 cases, 437 groups of data) was measured by JH20-1C type icterus instrument in 0.5h. Oh (193 cases), 12 h-24h (175 cases) after phototherapy of newborns, 12 h-24h (175 cases), and the left chest occlusion within 0.5 h, right, right TcB.2. in the chest, the eyebrows and the scapula part of the neonatal hyperbilirubinemia with gestational age more than 32 weeks and the birth weight more than 1500g were randomly divided into two groups: simple phototherapy group (phototherapy group, 67 cases), only phototherapy; phototherapy combined with Yin Gardenia group (joint group, 69 cases), 2ml/ (kg. times) of phototherapy and Yin Zhi Huang oral liquid, each 12 h 1 For 5 days, 5 days. Every 12 h monitored the level of percutaneous bilirubin (TcB) under the occlusion of the left margin of the sternum. Record two groups of children's general data, group 0h, sixtieth h, and group 120th h TcB level. The incidence of adverse reactions, such as light therapy time, light therapy rate, rash and diarrhea, was included in the group 120 h. SPSS 20 software was used to select correlation analysis. The difference analysis, the consistency analysis, the t test, the chi square test, the variance analysis of the repeated measurement data and the moment correlation analysis. Results: before 1. phototherapy, the TcB and TSB had higher correlation and consistency (all P0.05), the TcB of the anterior chest was the best and the TSB difference was the smallest. After the phototherapy stopped, the difference between the TSB and the left chest covered TcB was the smallest. (-1.2 + 2.3mg/dl, -0.5 + 1.6mg/dl), the correlation and consistency were the best. The difference value of (TSB- anterior chest TcB) was 1.5 + 1.6mg/dl when TSB was greater than 15mg/dl before the phototherapy, and the difference was statistically significant. At present, when the TcB value of the chest or left chest cover is lower than that of phototherapy or stop phototherapy, the TSB threshold is greater than 3.3 mg/dl or 2.6 mg/dl, the false negative rate is less than 2.5%, and the present TcB value of the thoracic or left chest cover is lower than the TSB threshold of the phototherapy or the stop phototherapy with the TSB threshold greater than 4.2 mg/dl or 3.2 mg/dl, and the false negative rate is lower than the sixtieth h Tc between the 1%.2. phototherapy group and the combined group. The level of B was similar (P0.05). The level of 120th h TcB in the combined group was lower than that in the phototherapy group. The difference was statistically significant (9.4 + 1.1mg/dl to 9.8 + 1.4mg/dl, P0.045). The level of TcB in the combined group was greater than that in the phototherapy group. The combined group and the group of phototherapy group were in 120h (70.1 + 13.0h to 72 + 13.4 h), and the rate of phototherapy (31.9% to 34.3%), Pi Zhenfa The rate of birth (10.1% to 9%) was not statistically significant (P0.05). The incidence of diarrhea in the combined group (21.7%) was significantly higher than that of the phototherapy group (11.9%), but the difference was not statistically significant (P=0.127). There was a significant linear correlation between the total frequency of stool in the combined group and the 120th h TcB level (r=0.75, P=0.000) in the combined group (120 h). The subgroup (41 cases) was in the group 60H, the decrease rate of the level 120hTcB (14 + 13.1%, 24.3 + 12.7%) was lower than that in the subgroup (26.9 + 13.4%, 35.4 + 11.7%), and the difference was statistically significant (P=0.000,0.000). 6%) the rash (9.8% to 10.7%) and the incidence of diarrhea (24.4% to 17.9%) were not statistically significant (P0.05). Conclusion: before 1. phototherapy, the anterior chest TcB is the most accurate; after phototherapy, the left chest cover TcB is the most accurate, can replace the TSB for neonatal jaundice evaluation and management of.2. Yellow Gardenia in the adjuvant phototherapy for neonatal hyperbilirubinemia in the treatment of neonatal hyperbilirubinemia The effect is relatively slow, but the effect is relatively weak and can only be used as a supplementary therapy. The main adverse reaction is a slight increase in the number of stools. The number of stools is positively related to the curative effect. Yin Zhi Huang oral liquid can be used safely and effectively for the treatment of hyperbilirubinemia in foot and preterm infants, but it is used in premature infants. Lower than the full-term.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.1

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