LED蓝光管光疗治疗急性胆红素脑病能疗效观察

The effects of LED blue light tube phototherapy in the treatment of acute bilirubin encephalopathy

目的分析LED蓝光管光疗设备在重度高胆红素血症合并急性胆红素脑病新生儿中的临床疗效。方法选取2013年12月至2016年12月本院新生儿科收治、胎龄≥35周的重度高胆红素血症合并急性胆红素脑病新生儿的临床资料进行回顾性研究。2013年12月至2014年11月应用蓝光荧光管光疗的患儿为普通蓝光组，2014年12月至2016年12月应用LED蓝光管光疗的患儿为LED蓝光组。分析两组患儿血清总胆红素（total serum bilirubin，TSB）水平及胆红素致神经功能障碍（bilirubin－induced neurological dysfunction，BIND）评分变化，比较光疗前后血清神经元特异性烯醇化酶（neuron－specific enolase，NSE）水平，并对患儿生后3个月内神经系统情况进行随访。结果共纳入51例重度高胆红素血症合并急性胆红素脑病新生儿，其中普通蓝光组24例，LED蓝光组27例。两组患儿光疗前血清TSB水平、BIND评分差异均无统计学意义（P〉0.05）。LED蓝光组光疗后4 h、24 h和48 h血清TSB水平低于普通蓝光组[（331.3±21.8） μmol/L比（372.1±25.2） μmol/L，（233.6±20.4） μmol/L比（269.4±19.8） μmol/L，（184.5±15.2） μmol/L比（226.3±22.7） μmol/L]，差异有统计学意义（P〈0.05）；两组光疗后12 h TSB水平差异无统计学意义（P〉0.05）。LED蓝光组光疗后4 h BIND评分低于普通蓝光组[（4.0±0.6）分比（4.7±0.8）分]，差异有统计学意义（P〈0.05）；其余时间点两组BIND评分差异无统计学意义（P〉0.05）。两组光疗后血清NSE水平均较光疗前下降，LED蓝光组光疗结束时NSE水平低于普通蓝光组，总光疗时间短，全血置换例数少，差异均有统计学意义（P〈0.05）。随访至生后3个月，LED蓝光组患儿生后1、3个月脑干听觉诱发电位异常比例低于普通蓝光组，差异有统计学意义（P〈0.05），两组头颅磁共振成像异常比例差异无统计学意义（P〉0.05）。结论重度高胆红素血症合并急性胆红素脑病患儿应严密监测TSB水平，动态评价脑损伤指标，积极进行LED蓝光光疗可迅速降低血清TSB水平，有效遏制急性胆红素脑病的不良进程，降低换血率，未增加不良反应发生率。

ObjectiveTo study the clinical efficacy of LED blue light tube phototherapy in severe hyperbilirubinemia with acute bilirubin encephalopathy （ABE）.MethodClinical data of newborns admitted to neonatal department of our hospital between Dec. 2013 and Dec. 2016 were retrospectively reviewed. Infants with gestational age≥35 weeks who were diagnosed with severe hyperbilirubinemia and ABE were collected and analyzed. From Dec. 2013 to Nov. 2014, infants treated with common blue light tube were assigned into traditional blue light group （traditional group）. From Dec. 2014 to Dec. 2016, infants treated with LED blue light tube were assigned to LED blue light group （LED group）. Total serum bilirubin （TSB） levels and bilirubin induced neurological dysfunction （BIND） scores were analyzed between the two groups. Neuron specific enolase （NSE） levels before and after phototherapy were also compared. Follow-up data for three months after discharge were analyzed.ResultFifty-one infants with severe hyperbilirubinemia and ABE were included, with 24 cases in traditional group and 27 cases in LED group. There were no significant differences in TSB levels and BIND scores between the two groups before phototherapy （P〉0.05）. TSB levels at 4 h, 24 h and 48 h after phototherapy in LED group were significantly lower than traditional group respectively [（331.3±21.8） μmol/L vs. （372.1±25.2） μmol/L, （233.6±20.4） μmol/L vs. （269.4±19.8） μmol/L, （184.5±15.2） μmol/L vs. （226.3±22.7） μmol/L, P〈0.05]. However, there was no significant difference in TSB levels at 12 h after phototherapy between the two groups （P〉0.05）. BIND scores at 4 h after phototherapy in LED group were significantly lower than traditional group [（4.0±0.6） vs. （4.7±0.8）, P〈0.05]. There were no significant differences in BIND scores at other time points after phototherapy between the two groups （P〉0.05）. In both groups, serum NSE levels after phototherapy were lower than before phototherapy. Serum NSE level after phototherapy in the LED group was significantly lower than the traditional group （P〈0.05）. Total phototherapy duration of the LED group was significantly shorter than the traditional group （P〈0.05）. The incidence of exchange transfusion in LED group was significantly lower than traditional group. The incidence of abnormal brainstem auditory evoked potential in LED group were significantly lower than traditional group at 1 month and 3 months after birth （P〈0.05）. The proportion of abnormal cranial MRI between the two groups showed no statistical differences （P〉0.05）.ConclusionTSB levels and brain injury indicators should be closely monitored and evaluated in infants with severe hyperbilirubinemia and ABE. Active LED blue light phototherapy can rapidly reduce TSB levels, effectively control the progress of ABE, and reduce the ratio of exchange transfusion. Adverse reactions of LED blue light phototherapy are not observed in this study.