探讨强光疗治疗新生儿高胆红素血症的临床疗效与安全性

Study on the Clinical Efficacy and Safety of Intense Light Therapy in the Treatment of Neonatal Hyperbilirubinemia

目的研究强光疗治疗新生儿高胆红素血症的临床疗效与安全性。方法在2019年3月—2020年6月方便抽选该院收治的104例高胆红素血症新生儿作为研究对象,按双盲法将其分为常规组(给予普通光疗法治疗)和研究组(给予强光疗法治疗),每组52例。比较两组治疗前、治疗1 d后的经皮胆红素、间接胆红素、总胆红素水平和氧化应激指标(超氧化物歧化酶、丙二醛),并比较两组总光疗时间、黄疸消退时间、住院时间、再次光疗率、治愈率、不良反应发生率、光疗后血钙水平和血红蛋白下降幅度。结果治疗后,研究组经皮胆红素、间接胆红素、总胆红素、超氧化物歧化酶水平分别为(72.62±10.95)μmol/L、(74.20±9.63)μmol/L、(181.69±8.51)μmol/L、(188.96±10.74)μmol/L、(16.02±1.11)U/mL,均低于常规组的(99.52±12.54)μmol/L、(91.54±10.02)μmol/L、(205.63±10.57)μmol/L、(207.54±11.62)μmol/L、(19.52±1.20)U/mL,而丙二醛水平为(6.74±0.23)U/mL,高于常规组的(6.14±0.38)U/mL,差异有统计学意义(t=8.52、7.69、8.14、7.23、6.33、5.42,P<0.05);研究组总光疗时间、黄疸消退时间、住院时间分别为(27.51±5.14)h、(3.69±0.74)d、(4.52±0.38)d,短于常规组的(36.25±6.25)h、(5.01±0.81)d、(5.96±0.42)d,差异有统计学意义(t=5.40、6.02、12.71,P<0.05);研究组再次光疗率、不良反应发生率分别为5.77%、3.85%,低于常规组的19.23%、15.38%,差异有统计学意义(χ^(2)=3.98、4.31,P<0.05);研究组治愈率为96.15%,高于常规组的90.38%,差异无统计学意义(χ^(2)=0.61,P>0.05);研究组光疗后血钙水平为(2.21±0.99)mmol/L,较低于常规组的(2.36±0.81)mmol/L,而血红蛋白下降幅度为(29.58±15.18)g/L,略高于常规组(26.63±13.20)g/L,差异无统计学意义(t=0.58、0.73,P>0.05)。结论采用强光疗治疗新生儿高胆红素血症,能快速消除黄疸,降低患儿的经皮胆红素、间接胆红素、总胆红素水平,减少氧化应激反应,缩短光疗时间和住院时间,疗效理想,且不良反应低,能避免患儿再次光疗,安全性好。

Objective To study the clinical efficacy and safety of intense light therapy in the treatment of neonatal hyperbilirubinemia.Methods From March 2019 to June 2020,104 neonates with hyperbilirubinemia admitted to the hospital were conveniently selected as the research objects,according to the double-blind method,they were divided into the conventional group(given with ordinary light therapy)and the study group(given with strong light therapy),52 cases in each group.Compared the levels of transcutaneous bilirubin,indirect bilirubin,total bilirubin and oxidative stress indicators(superoxide dismutase,malondialdehyde)of the two groups before treatment and 1 d after treatment.The total phototherapy time,jaundice resolution time,hospitalization time,re-phototherapy rate,cure rate,incidence of adverse reactions,blood calcium level and hemoglobin decline after phototherapy were compared between the two groups.Results After treatment,the levels of percutaneous bilirubin,indirect bilirubin,total bilirubin and superoxide dismutase in the study group were(72.62±10.95)μmol/L,(74.20±9.63)μmol/L,(181.69±8.51)μmol/L,(188.96±10.74)μmol/L and(16.02±1.11)U/mL,compared with the convention group(99.52±12.54)μmol/L,(91.54±10.02)μmol/L,(205.63±10.57)μmol/L,(207.54±11.62)μmol/L,(19.52±1.20)U/mL,the malondialdehyde level was(6.74±0.23)U/mL,which was higher than that of the conventional group(6.14±0.38)U/mL,and the difference was statistically significant(t=8.52,7.69,8.14,7.23,6.33,5.42,P<0.05).The total phototherapy time,jaundice resolution time and hospital stay in the study group were(27.51±5.14)h,(3.69±0.74)d,(4.52±0.38)d,respectively which was was shorter than that in conventional group(36.25±6.25)h,(5.01±0.81)d,(5.96±0.42)d,and the difference was statistically significant(t=5.40,6.02,12.71,P<0.05);the rate of rephototherapy and the incidence of adverse reactions in the study group were 5.77%and 3.85%,respectively,lower than 19.23%and 15.38%in the conventional group,and the difference was statistically significant(χ^(2)=3.98,4.31,P<0.05).The cure rate of the study group was 96.15%,higher than that of the conventional group 90.38%,and the difference was not statistically significant(χ^(2)=0.61,P>0.05).The blood calcium level of the study group was(2.21±0.99)mmol/L after phototherapy,which was lower than that of the conventional group(2.36±0.81)mmol/L,and the decrease of hemoglobin was(29.58±15.18)g/L,which was slightly higher than that of the conventional group(26.63±13.20)g/L,and the difference was not statistically significant(t=0.58,0.73,P>0.05).Conclusion Intense phototherapy in the treatment of neonatal hyperbilirubinemia can quickly eliminate jaundice,reduce the levels of transcutaneous bilirubin,indirect bilirubin and total bilirubin,reduce oxidative stress reaction,shorten phototherapy time and hospitalization time,with ideal curative effect and low adverse reactions,which can avoid children's repeated phototherapy with good safety.