不同蓝光及照射方式治疗新生儿高胆红素血症临床分析

TREATMENT OF NEONATAL HYPERBILIRUBINEMIA BY DIFFERENT METHODS OF BLUE-LIGHT IRRADIATION

目的观察不同蓝光和不同照射方式治疗新生儿高胆红素血症的临床疗效及不良反应。方法选取127例高胆红素血症新生儿分为冷光源蓝光持续照射组(A组,n=32)、冷光源蓝光间歇照射组(B组,n=32)、传统蓝光持续照射组(C组,n=31)和传统蓝光间歇照射组(D组,n=32),四组疗程均为72 h,分别观察四组新生儿治疗前后血清总胆红素、直接胆红素水平、听性脑干反应,记录并比较四组新生儿与治疗相关的不良反应。结果四组治疗后的血清总胆红素水平较治疗前均有明显下降(p<0.01),且冷光源蓝光组的血清总胆红素水平较传统蓝光组降低更为明显(p<0.05);冷光源蓝光组有效率明显高于传统蓝光组(p<0.05);冷光源蓝光组不良反应率明显低于传统蓝光组(p<0.01),且C组的不良反应率明显高于D组(p<0.05);治疗后3d冷光源蓝光组听性脑干反应异常率明显低于传统蓝光组(p<0.05);治疗后3个月四组的听性脑干反应异常率比较无统计学意义(p>0.05);治疗后9个月四组听性脑干反应均恢复正常。结论采用冷光源蓝光照射治疗新生儿高胆红素血症临床效果明显,可以有效降低新生儿听力损害,且间断照射与持续照射的总有效率和不良反应发生率相当。

Objective To study the clinical efficacy and adverse reactions of different blue- light and exposure patterns for the treatment of neonatal hyperbilirubinemia. Methods 127 neonates with hyperbilirubinemia were divided into cold- light illuminator blue- light irradiation group（ group A,n = 32）,cold- light illuminator blue-light group intermittent irradiation group（ group B,n = 32）,traditional blue- light irradiation group（ group C,n =31） and traditional blue- light intermittent irradiation group（ group D,n = 32）. The treatment course of the four groups was all 72 hours. The level of serum total bilirubin（ TBIL）,direct bilirubin（ DBIL） and auditory brainstem response before and after treatment in the four groups were respectively observed and compared. The adverse reactions associated with treatment were recorded and compared among the four groups. After 9 months of follow- up,the auditory brainstem response（ ABR） was respectively tested at 3 days,3 months and 9 months after the treatment. Results The level of TBIL in the four groups after treatment were significantly decreased compared with that before treatment（ p 〈 0. 01）,and the level of TBIL in cold- light illuminator blue- light group was significantly decreased compared with that in traditional blue- light group（ p 〈 0. 05）. The total effectiveness in cold- light illuminator blue- light group was significantly higher than that in traditional blue- light group（ p 〈 0. 05）. The incidence of adverse reaction in cold- light illuminator blue- light group was significantly lower than that in traditional blue- light group（ p 〈0. 01）,and the incidence of adverse reaction in group C was significantly higher than that in group D（ p 〈 0. 05）. At day 3 after treatment,the abnormal rates of ABR in the cold- light illuminator blue- light group was significantly lower than that in the traditional blue- light group（ p 〈 0. 05）. After 3 months of treatment,the abnormal rates of ABR was insignificantly different among the four groups（ p 〉 0. 05）. The ABR in the four groups returned to the normal after 9 months of treatment. Conclusion The therapy of the cold- light illuminator blue- light irradiation has significant clinical efficacy in the treatment of neonatal hyperbilirubinemia. It can effectively reduce the hearing impairment of neonates,and the incidence of adverse reaction and total effective rates are equivalent in therapeutic patterns of intermittent irradiation and continuous irradiation.