间歇蓝光照射联合静脉滴注白蛋白治疗新生儿病理性黄疸患儿的临床疗效

Clinical effect of intermittent blue light phototherapy combined with intravenous infusion of albumin on neonatal pathological jaundice

目的 探讨不同蓝光照射方式联合静脉滴注白蛋白治疗新生儿病理性黄疸的临床疗效及其安全性。方法 选取2015年2月至2017年10月,东营市东营区人民医院收治的82例新生儿病理性黄疸患儿为研究对象。采用掷硬币随机方法进行分组,将其分为实验组(n=41,接受间歇蓝光照射+静脉滴注白蛋白)和对照组(n=41,接受连续蓝光照射+静脉滴注白蛋白)。采用成组t检验,对2组患儿的新生儿出生体重、胎龄,以及血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、超敏C反应蛋白(HS-CRP)、总胆汁酸(TBA)、游离脂肪酸(FFA)、碱性磷酸酶(AKP)及γ-谷氨酰转肽酶(γ-GT)水平等进行统计学比较。采用χ2检验,对2组患儿的性别构成比、治疗总有效率及不良反应率进行统计学分析。本研究遵循的程序符合东营市东营区人民医院伦理委员会所制定的伦理学标准,得到该委员会批准(批准文号:20150103),所有受试儿监护人均签署临床研究知情同意书。结果 ①2组患儿的性别构成比、新生儿出生体重和胎龄分别比较,差异均无统计学意义(P>0.05)。②实验组患儿治疗后第7天血清TBIL、DBIL与IBIL水平分别为(153.9±9.6)μmol/L、(8.2±2.4)μmol/L和(139.6±8.9)μmol/L,均显著低于治疗前的(208.2±11.2)μmol/L、(20.9±2.8)μmol/L和(191.3±8.1)μmol/L,组内分别比较,差异均有统计学意义(t=23.549、23.055、27.429,P<0.001)。对照组患儿治疗后第7天血清TBIL、DBIL与IBIL水平分别为(157.4±7.9)μmol/L、(8.9±1.5)μmol/L、(142.0±7.2)μmol/L,亦显著低于治疗前的(210.8±10.9)μmol/L、(21.3±3.1)μmol/L、(192.9±8.9)μmol/L,并且差异均有统计学意义(t=25.400、22.154、28.470,P<0.001)。此外,2组患儿治疗前与治疗后第7天的血清TBIL、DBIL与IBIL水平分别组间比较,差异均无统计学意义(P>0.05)。③实验组患儿治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别为(1.3±0.3)mg/L、(12.3±3.4)μmol/L、(2493.0±199.7)μmol/L、(126.2±10.2)μmol/L、(60.5±10.3)μmol/L,均显著低于治疗前的(3.4±0.4)mg/L、(32.6±5.9)μmol/L、(4049.8±132.8)μmol/L、(238.7±11.4)μmol/L、(151.7±11.3)μmol/L,并且差异均有统计学意义(t=26.091、19.138、41.560、47.061、38.174,P<0.001)。对照组患儿治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别为(1.3±0.1)mg/L、(14.6±2.1)μmol/L、(2546.4±224.1)μmol/L、(129.0±9.4)μmol/L、(63.0±9.2)μmol/L,均显著低于治疗前的(3.3±0.5)mg/L、(33.4±6.3)μmol/L、(4009.5±121.5)μmol/L、(242.4±10.6)μmol/L、(154.2±10.6)μmol/L,并且差异均有统计学意义(t=23.781、18.119、36.750、51.306、41.420,P<0.001)。此外,2组患儿治疗前与治疗后第7天的HS-CRP、TBA、FFA、AKP和γ-GT水平分别组间比较,差异均无统计学意义(P>0.05)。④实验组患儿治疗总有效率为95.1%(39/41),与对照组的92.7%(38/41)比较,差异无统计学意义(χ2=0.210,P=0.644)。⑤实验组患儿腹泻、脱水、体温升高、奶量减少、哭闹与烦躁发生率,均低于对照组,2组分别比较,差异均有统计学意义(χ2=4.491、6.252、5.623、7.291、5.143,P=0.032、0.013、0.024、0.012、0.022)。结论 间歇蓝光照射结合静脉滴注白蛋白对新生儿病理性黄疸的疗效较好,并且能明显降低患儿不良反应发生率。

Objective To investigate the clinical efficacy and safety of different blue light phototherapy methods combined with intravenous albumin infusion in the treatment of neonatal pathological jaundice. Methods From February 2015 to October 2017, 82 cases of neonatal pathological jaundice admitted to Dongying District People′s Hospital in Dongying City were selected into this study. They were randomly divided into experimental group ( n =41, received intermittent blue light irradiation+intravenous albumin infusion) and control group ( n =41, received continuous blue light irradiation+intravenous albumin infusion). Independent-samples t test was used to statistically compare the neonatal weight, gestational age, and serum total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), hypersensitive C-reactive protein (HS-CRP), total bile acid (TBA), free fatty acid (FFA), alkaline phosphatase (AKP) and γ-glutamyltranspeptidase (γ-GT) levels between two groups. Chi-square test was used to statistically analyze the gender composition ratio, total effective rate and incidence of adverse reactions between two groups. The procedure followed in this study conforms to the ethical standards formulated by the Medical Ethics Committee of People′s Hospital of Dongying District, Dongying City, and has been approved by the Committee (Approval No. 20150103). All subjects have signed informed consent forms for clinical research. Results ① There were no significant differences in the aspects of gender composition ratio, body weight and gestational age between two groups ( P >0.05).② The levels of serum TBIL, DBIL and IBIL in experimental group were (153.9±9.6)μmol/L,(8.2±2.4)μmol/L and (139.6±8.9)μmol/L, respectively on the 7th day after treatment, which were significantly lower than (208.2±11.2)μmol/L,(20.9±2.8)μmol/L and (191.3±8.1)μmol/L before the treatment. The differences between two groups were statistically significant ( t =23.549, 23.055, 27.429;P <0.001). The levels of serum TBIL, DBIL and IBIL on the 7th day after treatment of control group were (157.4± 7.9)μmol/L,(8.9±1.5)μmol/L,(142.0±7.2)μmol/L, respectively, which were also significantly lower than that (210.8±10.9)μmol/L,(21.3±3.1)μmol/L,(192.9±8.9)μmol/L before treatment. And the differences were statistically significant ( t =25.400, 22.154, 28.470, P <0.001). In addition, there were no significant differences between two groups in the levels of serum TBIL, DBIL and IBIL before and on the 7th day after treatment ( P >0.05).③ The levels of HS-CRP, TBA, FFA, AKP and γ-GT on the 7th day after treatment in experimental group were(1.3±0.3)mg/L,(12.3±3.4)μmol/L,(2 493.0± 199.7)μmol/L,(126.2±10.2)μmol/L,(60.5±10.3)μmol/L, respectively, which were significantly lower than that (3.4±0.4)mg/L(32.6±5.9)μmol/L,(4 049.8± 132.8)μmol/L,(238.7± 11.4)μmol/L,(151.7±11.3)μmol/L before the treatment. And the differences were statistically significant ( t =26.091, 19.138, 41.560, 47.061, 38.174, P <0.001). The levels of HS-CRP, TBA, FFA, AKP and γ-GT on the 7th day after treatment in control group were (1.3± 0.1)mg/L,(14.6±2.1)μmol/L,(2 546.4±224.1)μmol/L,(129.0±9.4)μmol/L,(63.0±9.2)μmol/L, which were significantly lower than (3.3±0.5)mg/L,(33.4±6.3)μmol/L,(4 009.5±121.5)μmol/L,(242.4±10.6)μmol/L,(154.2±10.6)μmol/L before the treatment. And the differences were statistically significant ( t =23.781, 18.119, 36.750, 51.306, 41.420;P <0.001). In addition, there were no significant differences between two groups in the levels of HS-CRP, TBA, FFA, AKP and γ-GT before treatment and on the 7th day after the treatment ( P >0.05).④ The total effective rate of experimental group was 95.1%(39/41), which was higher than 92.7%(38/41) of control group. But there was no significant difference between two groups (χ 2 =0.210, P =0.644).⑤ The incidence of adverse reactions, such as diarrhea, dehydration, body temperature rise, milk volume decrease, crying and dysphoria in experimental group were lower than those in control group, and all the differences between two groups were statistically significant (χ 2 =4.491,6.252,5.623,7.291,5.143;P = 0.032,0.013,0.024,0.012,0.022). Conclusions Intermittent blue light phototherapy combined with intravenous albumin infusion has a better effect on neonatal pathological jaundice, and can significantly reduce the incidence of adverse reactions in children.