运用经皮胆红素水平评价茵栀黄口服液在新生儿高胆红素血症中的应用

发布时间：2018-07-13 18:24

【摘要】：目的:探讨光疗前后前胸(遮盖及未遮盖)、眉心、肩胛部位经皮胆红素(TcB)值,与同时测定的血清胆红素(TSB)值比较,分析其准确性。运用经皮胆红素水平评价茵栀黄口服液对新生儿(尤其是早产儿)高胆红素血症的疗效及安全性。方法:选自2015年9月至2016年7月入住我院新生儿科的新生儿。1.符合入选标准后检查TSB,并在0.5h内采用JH20-1C型经皮黄疸仪测定前胸、眉心、肩胛部位的TcB(364例,437组数据)。新生儿光疗停止后Oh(193例)、12 h-24h(175例)测定TSB值,并在0.5 h内测定左胸遮盖、右胸、眉心、肩胛部位的TcB。2.将胎龄≥32周且出生体重≥1500g的新生儿高胆红素血症患儿用随机数字法随机分为两组:单纯光疗组(光疗组,67例),仅给予光疗治疗;光疗联合茵栀黄组(联合组,69例),给予光疗及茵栀黄口服液2ml/(kg.次),每12 h一次,连服5天。每12 h监测一次胸骨左缘贴片遮盖下的经皮胆红素(TcB)水平。记录两组患儿一般资料、入组第0h、第60 h和入组第120 h TcB水平、入组120 h内总计光疗时间、再光疗率、皮疹及腹泻等不良反应发生率。采用SPSS 20.0软件,选用相关分析、方差分析、一致性分析、t检验、卡方检验、重复测量数据的方差分析、积矩相关性分析。结果:1.光疗前,不同部位TcB与TSB均有较高的相关性及一致性(均P0.05),前胸TcB相对最佳、与TSB差值相对最小。光疗停止后0 h及12-24 h,TSB与左胸遮盖TcB差值最小(-1.2±2.3mg/dl、-0.5±1.6mg/dl),相关性及一致性均最佳。光疗前当TSB≥15mg/dl时,(TSB-前胸 TcB)差值 1.5±1.6mg/dl;当 TSB15mg/dl 时,(TSB-前胸 TcB)差值-1.9±1.9mg/dl,差异有统计学意义(P=0.000)。(TSB-前胸TcB)差值不受性别、胎龄、出生体重、测定时龄及重复测量影响。当前胸或左胸遮盖部位TcB值低于光疗或停光疗TSB阈值大于3.3 mg/dl或2.6 mg/dl时,假阴性率小于2.5%;当前胸或左胸遮盖部位TcB值低于光疗或停光疗TSB阈值大于4.2 mg/dl或3.2 mg/dl时,假阴性率小于1%。2.光疗组和联合组之间入组第60 h TcB水平相似(P0.05),联合组入组第120 h TcB水平低于光疗组,差异有统计学意义(9.4±1.1mg/dl对9.8±1.4mg/dl,P0.045)。联合组TcB水平下降程度大于光疗组。联合组与光疗组入组120h内总计光疗时间(70.1±13.0h对72.0±13.4 h)、再光疗率(31.9%对34.3%)、皮疹发生率(10.1%对9.0%)差异均无统计学意义(P0.05)。联合组腹泻发生率(21.7%)明显高于光疗组(11.9%),但差异尚无统计学意义(P=0.127)。联合组入组120 h内大便总次数与入组第120 h TcB水平下降值呈显著线性正相关关系(r=0.75,P=0.000)。联合组中早产儿亚组(41例)在入组第60h、第120hTcB水平下降率(14.0±13.1%、24.3±12.7%)均低于足月儿亚组(28 例)(26.9±13.4%、35.4±11.7%),差异均有统计学意义(P=0.000、0.000)。早产儿亚组与足月儿亚组入组120 h内总计光疗时间(72.3±14.8h 对 66.9±8.9h)、再光疗率(34.1%对 28.6%)、皮疹(9.8%对 10.7%)及腹泻发生率(24.4%对17.9%)的差异均无统计学意义(P0.05)。结论:1.光疗前,前胸TcB相对最准确;光疗后,左胸遮盖TcB最准确,能替代TSB用于新生儿黄疸的评估与管理。2.茵栀黄在辅助光疗治疗新生儿高胆红素血症方面有一定疗效,但起效相对较慢,作用相对较弱,仅能作为一种辅助疗法。不良反应主要是大便次数稍有增多。大便次数与疗效呈正相关。茵栀黄口服液可以一样安全有效地用于辅助光疗治疗足月儿及早产儿高胆红素血症,但用于早产儿疗效略低于足月儿。
[Abstract]:Objective: To investigate the value of the anterior chest (covering and uncovered) before and after phototherapy, the value of the skin bilirubin (TcB) of the eyebrows and the scapula, compared with the value of the serum bilirubin (TSB) measured at the same time, and analyze its accuracy. The effect and safety of the peric bilirubin level on the hyperbilirubinemia of the newborns (especially preterm infants) were evaluated by the percutaneous bilirubin level. Method: 2 The newborn.1. from September to July 2016 of 015 years was checked with TSB, and the TcB (364 cases, 437 groups of data) was measured by JH20-1C type icterus instrument in 0.5h. Oh (193 cases), 12 h-24h (175 cases) after phototherapy of newborns, 12 h-24h (175 cases), and the left chest occlusion within 0.5 h, right, right TcB.2. in the chest, the eyebrows and the scapula part of the neonatal hyperbilirubinemia with gestational age more than 32 weeks and the birth weight more than 1500g were randomly divided into two groups: simple phototherapy group (phototherapy group, 67 cases), only phototherapy; phototherapy combined with Yin Gardenia group (joint group, 69 cases), 2ml/ (kg. times) of phototherapy and Yin Zhi Huang oral liquid, each 12 h 1 For 5 days, 5 days. Every 12 h monitored the level of percutaneous bilirubin (TcB) under the occlusion of the left margin of the sternum. Record two groups of children's general data, group 0h, sixtieth h, and group 120th h TcB level. The incidence of adverse reactions, such as light therapy time, light therapy rate, rash and diarrhea, was included in the group 120 h. SPSS 20 software was used to select correlation analysis. The difference analysis, the consistency analysis, the t test, the chi square test, the variance analysis of the repeated measurement data and the moment correlation analysis. Results: before 1. phototherapy, the TcB and TSB had higher correlation and consistency (all P0.05), the TcB of the anterior chest was the best and the TSB difference was the smallest. After the phototherapy stopped, the difference between the TSB and the left chest covered TcB was the smallest. (-1.2 + 2.3mg/dl, -0.5 + 1.6mg/dl), the correlation and consistency were the best. The difference value of (TSB- anterior chest TcB) was 1.5 + 1.6mg/dl when TSB was greater than 15mg/dl before the phototherapy, and the difference was statistically significant. At present, when the TcB value of the chest or left chest cover is lower than that of phototherapy or stop phototherapy, the TSB threshold is greater than 3.3 mg/dl or 2.6 mg/dl, the false negative rate is less than 2.5%, and the present TcB value of the thoracic or left chest cover is lower than the TSB threshold of the phototherapy or the stop phototherapy with the TSB threshold greater than 4.2 mg/dl or 3.2 mg/dl, and the false negative rate is lower than the sixtieth h Tc between the 1%.2. phototherapy group and the combined group. The level of B was similar (P0.05). The level of 120th h TcB in the combined group was lower than that in the phototherapy group. The difference was statistically significant (9.4 + 1.1mg/dl to 9.8 + 1.4mg/dl, P0.045). The level of TcB in the combined group was greater than that in the phototherapy group. The combined group and the group of phototherapy group were in 120h (70.1 + 13.0h to 72 + 13.4 h), and the rate of phototherapy (31.9% to 34.3%), Pi Zhenfa The rate of birth (10.1% to 9%) was not statistically significant (P0.05). The incidence of diarrhea in the combined group (21.7%) was significantly higher than that of the phototherapy group (11.9%), but the difference was not statistically significant (P=0.127). There was a significant linear correlation between the total frequency of stool in the combined group and the 120th h TcB level (r=0.75, P=0.000) in the combined group (120 h). The subgroup (41 cases) was in the group 60H, the decrease rate of the level 120hTcB (14 + 13.1%, 24.3 + 12.7%) was lower than that in the subgroup (26.9 + 13.4%, 35.4 + 11.7%), and the difference was statistically significant (P=0.000,0.000). 6%) the rash (9.8% to 10.7%) and the incidence of diarrhea (24.4% to 17.9%) were not statistically significant (P0.05). Conclusion: before 1. phototherapy, the anterior chest TcB is the most accurate; after phototherapy, the left chest cover TcB is the most accurate, can replace the TSB for neonatal jaundice evaluation and management of.2. Yellow Gardenia in the adjuvant phototherapy for neonatal hyperbilirubinemia in the treatment of neonatal hyperbilirubinemia The effect is relatively slow, but the effect is relatively weak and can only be used as a supplementary therapy. The main adverse reaction is a slight increase in the number of stools. The number of stools is positively related to the curative effect. Yin Zhi Huang oral liquid can be used safely and effectively for the treatment of hyperbilirubinemia in foot and preterm infants, but it is used in premature infants. Lower than the full-term.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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