双面和三面蓝光照射治疗新生儿高间接胆红素血症临床疗效分析

目的探讨双面光疗和三面光疗治疗新生儿高间接胆红素血症的疗效。方法将所选68例高间接胆红素血症患儿随机分为双面光疗组和三面光疗组,各34例,分别给予双面蓝光和三面蓝光照射治疗,治疗前后测血液总胆红素,间接胆红素,在光疗期间每4小时监测经皮胆红素,并记录皮疹,腹泻副作用。结果双面光疗组24h时血清胆红素为(147.4±23.1)μmol/L,与三面光疗组的(140.6±21.0)μmol/L比较,差异无统计学意义(P=0.21);光疗4h时,三面光疗组经皮胆红素水平为(230.7±21.7)μmol/L,显著低于双面光疗组的(241.3±20.7)μmol/L,差异有统计学意义(P=0.04);两组蓝光照射治疗后双面光疗组皮疹+腹泻的发生数为10例次,三面光疗组皮疹+腹泻发生数为19例次,差异有统计学意义(P<0.05)。结论三面光疗和双面光疗能达到相同的降低间接胆红素的效果,但三面光疗皮疹和腹泻的发生率较双面光疗升高,临床中双面光疗是治疗新生儿高间接胆红素的适宜选择;重度高间接胆红素新生儿在光疗的前4h可以考虑采用三面光疗法,以迅速降低胆红素。

Objective To compare the efficacy of double and triple phototherapy in newborns with hyperbilirubinemia. Methods 68 cases were randomly assigned to triple or double phototherapy groups. Total and indirect serum bilirubin was measured before and after treatment. Transcutaneous bilirubin levels were recorded every 4 hours during phototherapy, so were the side effects of rash and diarrhea.Results The serum bilirubin of double phototherapy group was （ 147.4±23.1 ）Nmol/L after 24 hours treatment, and triple phototherapy group was （ 140.6±21.0） μmol/L. There was no statistically significant difference （P = 0.21） between double and triple phototherapy groups. 4 hours after treatment, average transcutaneous bilirubin level of triple phototherapy group was （230.7±21.7 ）gmol/L, significantly lower than the double phototherapy group, whose level was （241.3±20.7 ） μmol/L, with a statistically significant difference （P=0.04）. There were 10 cases in double phototherapy who got rash and diarrhea after treatment, while 19 cases in triple phototherapy, with a significant difference （P 〈0.05）. Conclusion Both double and triple phototherapy can achieve the same effect of reducing indirect bilirubin, but the incidence of rash and diarrhea in triple phototherapy group was higher than that in double phototherapy group. So it is suitable to treat babies of hyperbilirubinemia with double phototherapy. Babies with serious hyperbilirubinemia can choose triple phototherapy in the first four hours, so that the bilirubin level cala decrease rapidly.