茵栀黄口服液联合蓝光照射对新生儿黄疸的临床诊治研究

发布时间：2018-03-13 02:02

本文选题：新生儿黄疸　切入点：胆红素水平　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：观察茵栀黄口服液联合蓝光照射对新生儿黄疸湿热郁蒸证的临床疗效。方法：(1)将我院2014年10月-2015年9月收治的新生儿黄疸138例患儿,采用经皮总胆红素测量(TCB)及血清胆红素测量(TSB)方法,选取106例新生儿湿热郁蒸证患儿为研究资料,分为观察组及对照组各53例,分析新生儿黄疸的相关危险因素,探究新生儿黄疸的病情严重程度；(2)对照组采用单纯蓝光照射治疗,观察组在对照组基础上联合使用茵栀黄口服液治疗,观察分析两组患儿的一般资料及临床效果。结果：(1)经皮胆红素测定,临床诊断准确率为97.83%：经血清胆红素测定,临床诊断准确率为71.01%。新生儿黄疸相关因素主要包括：胎龄、性别、出生体重、胎膜早破、头颅血肿等。其中,随着胎儿胎龄和体重的增加,新生儿黄疸发病率呈明显的下降趋势(P0.05)；而胎膜早破时间、开奶时间、胎便排出时间等时间延长,导致新生儿出现黄疸的发病率上升(P0.05)。经过多因素回归分析,胎龄、新生儿出生体重是新生儿黄疸的主要保护因素(P0.05),而胎膜早破、开奶时间、母子血型不合以及同胞中有黄疸则为新生儿黄疸病情严重程度加重的主要危险因素(P0.05)。(2)两组患儿一般资料的差异无统计学意义(P0.05)。治疗后观察组有效率96.22%,对照组治疗有效率71.70%,差异显著(P0.05)。治疗后观察组血清胆红素水平优于对照组,差异显著(P0.05)。两组血清胆红素水平恢复情况及黄疸持续时间比较,观察组均优于对照组(P0.05)。两组患儿的蓝光照射治疗时间及住院治疗时间比较,观察组优于对照组(P0.05)。两组患儿治疗过程中及治疗后不良反应发生率比较,观察组低于对照组(P0.05)。两组患者对治疗效果的满意程度比较,观察组优于对照组(P0.05)。结论：经皮胆红素测定诊断符合率高,可重复性强、操作简单、无创伤、风险小、家长乐于接受。新生儿黄疸存在很多相关因素,其中胎龄、新生儿出生体重是新生儿黄疸的主要保护因素,而胎膜早破、开奶时间、母子血型不合以及同胞中有黄疸则为新生儿黄疸病情严重程度加重的主要危险因素。蓝光照射治疗容易受到黄疸病因、照射时间长度、光照面积、患儿皮肤光照度等因素的影响而产生副作用；茵栀黄口服液具有保肝利胆、清热退黄,改善患儿症候,预防并发症的作用。两者联合使用可有效改善患儿血清胆红素水平、降低黄疸持续时间、蓝光照射时间及住院治疗时间,减少不良反应的作用。
[Abstract]:Objective: to observe the clinical effect of Yinzhihuang oral liquid combined with blue light irradiation on neonatal jaundice with damp-heat stagnation and steaming. Methods: from October 2014 to September 2015, 138 cases of neonatal jaundice were treated in our hospital. By means of percutaneous total bilirubin measurement (TCBB) and serum bilirubin measurement (TSBs), 106 neonates with dampness and heat stagnation were selected as the study data, and were divided into the observation group (n = 53) and the control group (n = 53). The risk factors of neonatal jaundice were analyzed. To explore the severity of neonatal jaundice, the control group was treated by pure blue light irradiation, while the observation group was treated with Yinzhihuang oral liquid on the basis of the control group. Observation and analysis of the general data and clinical effects of the two groups. Results the accuracy of clinical diagnosis was 97.83. The accuracy rate of clinical diagnosis was 71.01 by serum bilirubin measurement. The main factors related to neonatal jaundice included gestational age, sex, and sex. Birth weight, premature rupture of membranes, cranial hematoma, etc. Among them, with the increase of fetal age and body weight, the incidence of neonatal jaundice showed a significant downward trend (P0.05), while the time of premature rupture of membranes, the time of milk opening and the time of fecal excretion were prolonged. The incidence of neonatal jaundice increased (P 0.05). By multivariate regression analysis, neonatal birth weight was the main protective factor for neonatal jaundice, while premature rupture of membranes and time of milking. Blood group incompatibility between mother and son and jaundice in sibling were the main risk factors of exacerbation of neonatal jaundice. (P0.05) there was no significant difference in general data between the two groups. After treatment, the effective rate of observation group was 96.22%, while that of control group was 96.22%. The effective rate was 71.70, the difference was significant (P 0.05). After treatment, the serum bilirubin level in the observation group was better than that in the control group. The recovery of serum bilirubin level and the duration of jaundice in the two groups were significantly higher than those in the control group (P 0.05). The observation group was superior to the control group (P 0.05). The incidence of adverse reactions during and after treatment in the two groups was lower than that in the control group (P 0.05). Conclusion: the diagnostic accuracy rate of percutaneous bilirubin determination is high, reproducibility is strong, operation is simple, no trauma, risk is small, parents are willing to accept it. There are many related factors in neonatal jaundice, including gestational age, neonate jaundice. Neonatal birth weight is the main protective factor of neonatal jaundice, and premature rupture of membranes, milk opening time, Maternal and child blood group incompatibility and jaundice among siblings were the main risk factors for the severity of neonatal jaundice. Yinzhihuang oral liquid has the functions of protecting liver and promoting gallbladder, clearing away heat and removing yellow, improving symptoms and preventing complications. The combined use of both can effectively improve the serum bilirubin level of children. Reduce the duration of jaundice, blue light irradiation time and hospitalization time, reduce adverse reactions.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.17

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