摘要
目的探讨新生儿重度及以上高胆红素血症冷光源强光治疗的临床效果。方法选取2016年6月—2022年1月我院新生儿科住院的217例重度及以上高胆红素血症新生儿,采用冷光源强光照射治疗,4~6 h后检测患儿血清中总胆红素值(STB),如STB下降,或免疫性溶血STB下降≥34~50μmol/L,继续持续冷光源强光治疗18~24 h,期间8~12 h检测一次患儿STB。当STB值降至342.0μmol/L以下时,改为标准光疗。如冷光源强光治疗4~6 h,STB下降未达到目标值,或有急性胆红素脑病早期表现者,停止光疗,立即进行换血治疗。结果217例患儿中,2例患儿冷光源强光治疗失败,采用换血治疗,其余215例采用冷光源强光治疗4~6、12~14及20~24 h后,STB水平分别下降(40.6±14.9)、(61.2±17.7)、(114.7±49.4)μmol/L。冷光源强光照射治疗的时间为(32.3±14.5)h。治疗5~9 d,观察患儿STB不再上升后出院。出院后1周内所有患儿听力筛查均正常,行脑干听觉诱发电位(BAEP)检查的96例患儿未发现异常,所有患儿颅脑MRI检查均未发现异常。215例患儿中出院随访1年者134例,随访1~6个月者43例,随访1个月后失访者38例。随访的患儿体格生长、运动发育、神经行为临床评估及BAEP、MRI检查均未发现异常表现。结论重度及以上新生儿高胆红素血症采用冷光源强光治疗效果显著,可选择性地采取非换血冷光源强光照射等综合治疗。
Objective To investigate the clinical effect of strong light therapy with cold light source in the treatment of severe neonatal hyperbilirubinemia.Methods A total of 217 neonates with severe hyperbilirubinemia who were hospitalized in Department of Neonatology in our hospital from June 2016 to January 2022 were enrolled and treated with strong light therapy with cold light source.Serum total bilirubin(STB)was measured after 4-6 h,and if STB decreased or immunohemolytic STB decreased by≥34-50μmol/L,strong light therapy with cold light source was continued for 18-24 h,with STB tested once during 8-12 h.When STB decreased to below 342.0μmol/L,the treatment was changed to standard phototherapy.If STB did not decrease to the target value after 4-6 h of strong light therapy with cold light source or the early manifestation of acute bilirubin encephalopathy was observed,phototherapy was stopped and switched to exchange transfusion immediately.Results Among the 217 neonates,2 showed no response to strong light therapy with cold light source and were treated with exchange transfusion,and the other 215 neonates achieved a reduction in STB of(40.6±14.9),(61.2±17.7),and(114.7±49.4)μmol/L,respectively,after 4-6 h,12-14 h,and 20-24 h of strong light therapy with cold light source.The mean duration of strong light therapy with cold light source was(32.3±14.5)h.After treatment for 5-9 d,the neonates were discharged when there was no increase in STB.Hearing screening within 1 week after discharge showed normal results;brainstem auditory evoked potential(BAEP)examination was performed for 96 neonates and showed no abnormality;all neonates had normal MRI results.Of all neonates,134 were followed up for 1 year,43 were followed up for 1-6 months,and 38 were lost to follow-up after 1 month.The neonates who were followed up had normal physical growth,motor development,neurobehavioral assessment,BAEP,and MRI results.Conclusion Strong light therapy with cold light source has a marked clinical effect in the treatment of severe ne
作者
郑代明
王文添
蔡再鑫
ZHENG Daiming;WANG Wentian;CAI Zaixin(Department of Neonatology,Maternal and Child Care Service Centre of Shishi City,Shishi 362700,China)
出处
《精准医学杂志》
2023年第5期444-446,450,共4页
Journal of Precision Medicine
