早产儿黄疸早期干预的临床观察

Effects of early treatment on jaundice in premature infants

目的探讨早期干预早产儿黄疸的疗效和对肠外营养及体质量增长的影响。方法174例早产儿,出生体质量1500～2000g者(A组)87例,出生体质量<1500g者(B组)87例,分别按常规干预和早期干预分组。常规组血清总胆红素(TSB)达干预推荐方案的标准时光疗,早期组于出现黄疸,但TSB未达干预标准即光疗。结果A、B组的早期组胆红素峰值(PSB)均低于常规组[A组:(209.48±38.99)μmol/L和(266.59±37.11)μmol/L,B组:(180.23±31.63)μmol/L和(243.68±37.45)μmol/L,P均<0.05];早期组与常规组相比黄疸消退日龄早[A组:(14.5±4.4)d和(18.0±3.8)d,B组:(10.8±3.0)d和(18.8±5.5)d,P均<0.05],脂肪乳起始日龄早[A组:(5.8±2.7)d和(8.1±3.7)d,P>0.05;B组:(3.8±1.8)d和(9.2±4.4)d,P<0.05],恢复出生体质量日龄早[A组:(13.1±6.0)d和(14.4±4.0)d,P>0.05;B组:(9.3±4.8)d和(15.4±5.6)d,P<0.05]。结论早期干预可以使早产儿尤其是极低出生体重儿PSB降低,黄疸持续时间缩短,利于早期添加脂肪乳和早产儿体质量增长。

Objective To investigate the clinical effects of early phototherapy of jaundice in premature infants and its influence on parenteral nutrition and weight gain. Methods 87 premature infants with birth-weight between 1500 -2000 g （group A） and 87 premature infants with birth-weight less than 1500 g （group B） were enrolled into the study. In each group, subjects were divided into two subgroups, i.e. conventional treatment group, with the treatment conducted according to the recommended guidelines of treatment for neonatal jaundice which was constituted in 2000 ; and the early treatment group, with treatment earlier than the above recommended guidelines. Comparisons were made between subgroups in A and B groups. SPSSll. 0 software was used for statistical analysis of data. Results Peak serum bilirubin （PSB） level in early treatment group was significantly higher than that in conventional treatment group both in group A and B[ （209.48 ±38.99） umol/L and （266.59 ±37. 11 ） umol/L in group A,P 〈0. 05 ; （ 180. 23 ±31.64）umol/L vs （243.68 ±37.45） umol/L in group B, P 〈 0. 05 ]. The time of jaundice disappearing in early treatment group was significantly earlier than that in conventional treatment group, both in group A and B[ （ 14. 5 ±4. 4） days vs （ 18.0 ±3.8） days in group A, P〈0.05;（10.8±3.0） days vs （18.8 ±5.5） days in group B, P〈0. 05]. Meanwhile, the early treatment group commenced intravenous lipid earlier than that of the conventional treatment group[ （5.8 ± 2.7 ） days vs （ 8.1 ±3.7 ） days in group A, P 〉 0. 05 ; （ 3.8 ± 1.8 ） days vs （ 9. 2 ± 4.4） days in group B,P 〈 0. 05） ]. The newborns in early treatment group regained their birth weight earlier than that of the conventional treatment group[ （ 13. 1 ±6.0） days vs （ 14.4±4.0） days in group A, P 〉0. 05 ; （9.3 ± 4. 8） days vs （ 15.4± 5.6） days in group B, P 〈 0. 05） ]. Conclusion If the premature infants were treated with phototherapy earlier, they would be having a lower level of PSB, and a shorter duration of jaundice, thus benefiting the parenteral nutrition and the weight gain.