摘要
目的 初步探讨胆道闭锁患儿术后测定皮肤胆红素动态变化与黄疸消退及预后的关系.方法 2009年7月至12月,收治黄疸患儿52例,男19例,女33例,年龄36 d～304 d,平均年龄83 d,包括胆汁淤积5例,胆道闭锁47例,采血测血清胆红素同时测其皮肤胆红素.同期收治非黄疸患儿59例,男28例,女31例,年龄26 d～200 d,平均年龄119 d,采血测血清胆红素同时测其皮肤胆红素.其中行Kasai手术胆道闭锁患儿23例,男8例,女15例,年龄36d～127d,平均年龄63d,测其住院期间每日皮肤胆红素并以其术后3个月血清总胆红素20μmol/L为界,将其分为黄疸是否消退两组,对比观察两组患儿住院期间皮肤胆红素及其下降水平.结果 皮肤胆红素（x）与血清总胆红素（y）呈线性回归关系,其回归方程为：y=0.945x-46.273（P＜0.05）.正常儿童的皮肤胆红素95%参考值范围为33.14～96.14μmol/L.黄疸消退患儿术后11 d、12 d皮肤胆红素水平（159 μmol/L和151μmol/L）显著低于黄疸未消退患儿（205 μmol/L和210 μmol/L）,差异有统计学意义（P＜0.05）.黄疸消退患儿术后平均每天皮肤胆红素下降较快（5.04 μmol/L vs 2.33 μmol/L,P＜0.05）.结论 测定皮肤胆红素是一种安全可靠的方法,可以较早反映胆道闭锁患儿术后黄疸消退情况.
Objective To study the relationship between the post-op transcutaneous bilirubin changes after Surgery and the prognosis in children with biliary atresia. Methods Between July 2009to December 2009,52 children（ 19 males and 33 female, age： 36 d～304 d, the mean age 83d, including 5cholestasis and 47 biliary atresia）with jaundice and 59 non-jaundiced children＇s （28 males and 31 females,aged 26 d～200 d and the mean age 119 d） were recruited for the study. The transcutaneous bilirubin and total serum bilirubin of children with jaundice and non-jaundice were measured at the same time. Twenty-three children with biliary atresia （8 males and 15 females, aged 36 d～ 127 d and the mean age 63 d） underwent Kasai operation. The children were divided into good or poor prognosis groups according to the serum bilirubin levels of 20 μmol/L three months after operation. Measurements were compared between the two groups during hospital stay. Results Linear regression oftranscutaneous bilirubin （x） correlated with that of serum bilirubin （y） （y = 0. 945x - 46. 273, P＜0. 05）. The 95% confidence interval of transcutaneous bilirubin in normal children was 33. 14～96. 14μmol/L. The transcutaneous bilirubin of children with good prognosis was significantly lower than that of children with poor prognosis on postoperative day 11 （ 159 μmol/L vs 205 μmol/L,P＜0. 05） and 12（151 μmol/L vs 210μmol/L,P＜0. 05）. Postoperative average daily decline of transcutaneous bilirubin in children with good prognosis was faster （5. 04 μmol/L vs 2. 33 μmol/L, P＜0. 05）. Conclusions Transcutaneous bilirubin measurement is a safe and reliable method of monitoring the decline of jaundice of children with biliary atresia.
出处
《中华小儿外科杂志》
CSCD
北大核心
2011年第1期21-24,共4页
Chinese Journal of Pediatric Surgery
基金
国家十一五课题（编号：2006BAI05A06）
关键词
胆道闭锁
胆红素
皮肤
Biliary atresia
Bilirubin
Skin
