极低出生体重早产儿不同光疗策略的临床效果研究

Clinical effects of different phototherapies on preterm infants with very low birth weight

目的探讨极低出生体重(VLBW)早产儿实施不同光疗策略的效果及并发症发生率。方法172例VLBW早产儿,按照光疗时长分为间歇组(79例)与持续组(93例)。间歇组进行13 h间歇光疗,持续组进行24 h持续光疗。比较两组光疗时长、不良反应发生率、胃肠道喂养情况、体重情况、钙磷代谢情况、并发症发生情况。结果间歇组14 d总光疗时长短于持续组,不良反应发生率11.4%低于持续组的23.7%,差异均有统计学意义(P<0.05)。间歇组14 d内喂养不耐受次数少于持续组,全胃肠道喂养时间短于持续组,差异均有统计学意义(P<0.05);两组消化道出血发生率及静脉高营养时间比较,差异无统计学意义(P>0.05)。两组出生14 d体重均高于出生体重,且间歇组出生14 d体重(1473.10±159.58)g高于持续组的(1425.81±146.81)g,差异均有统计学意义(P<0.05)。出生14 d时,两组血钙、血磷、血碱性磷酸酶比较,差异无统计学意义(P>0.05)。间歇组坏死性小肠结肠炎(NEC)、早产儿视网膜病(ROP)、脑室内出血(IVH)、粒细胞减少的发生率低于持续组,差异有统计学意义(P<0.05)。两组动脉导管未闭(PDA)、支气管肺发育不良(BPD)发生率比较,差异无统计学意义(P>0.05)。结论对VLBW早产儿给予13 h间歇光疗能够明显降低患儿的皮肤黄疸,明显优于24 h持续光疗,不良反应少,对VLBW早产儿的生长及胃肠道喂养影响小,治疗效果好,并可减少临床并发症,改善预后。

Objective To discuss the effects of different phototherapies and their incidences of complications in preterm infants with very low birth weight(VLBW).Methods 172 preterm infants with VLBW were divided into an intermittent group(79 cases)and a continuous group(93 cases)according to the duration of phototherapy.Infants of the intermittent group received an intermittent phototherapy for 13 h,while infants of the continuous group received a continuous phototherapy for 24 h.The duration of phototherapy,incidence of adverse reactions,gastrointestinal feeding,body weight,calcium and phosphorus metabolism and complications were compared between the two groups.Results The intermittent group had a total phototherapy time of 14 d,which was longer than that of continuous group,and the intermittent group had an incidence of adverse reactions of 11.4%,which was lower than 23.7%of the continuous group;the differences were statistically significant(P<0.05).The frequency of feeding intolerance within 14 d of the intermittent group was less than that of the continuous group,and the full enteral feedings time was shorter than that of the continuous group,and the difference was statistically significant(P<0.05).The differences in the incidence of gastrointestinal bleeding and the duration of intravenous hypernutrition between the two groups were not statistically significant(P>0.05).The two groups had higher weight on the 14th day after birth than their birth weight;the intermittent group had a weight on the 14th d after birth of(1473.10±159.58)g,which was higher than(1425.81±146.81)g of the continuous group;and the differences were statistically significant(P<0.05).On the 14th d after birth,the differences in blood calcium,phosphorus and alkaline phosphatase between the two groups were not statistically significant(P>0.05).The incidences of necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP),intraventricular hemorrhage(IVH)and granulocytopenia of the intermittent group were lower than those of the continuous group,and the differences were statistically significant(P<0.05).The differences in the incidences of patent ductus arteriosus(PDA)and bronchopulmonary dysplasia(BPD)between the two groups were not statistically significant(P>0.05).Conclusion An intermittent phototherapy for 13 h provided to preterm infants with VLBW can significantly reduce dermal icterus in children,which is significantly better than a continuous phototherapy for 24 h.The intermittent phototherapy also has less adverse reactions,little impacts on the growth and gastrointestinal feeding.It has good therapeutic effect with less clinical complications and improves prognosis.