早产儿黄疸早期干预的临床观察VIP免费

·336··论著·中国新生儿科杂志2008年第23卷第6期早产儿黄疸早期干预的临床观察刘颖朴梅花【摘要】目的探讨早期干预早产儿黄疸的疗效和对肠外营养及体质量增长的影响。方法174例早产儿，出生体质量1500～2000g者(A组)87例，出生体质量<1500g者(B组)87例，分别按常规干预和早期干预分组。常规组血清总胆红素(TSB)达干预推荐方案的标准时光疗，早期组于出现黄疸，但TSB未达干预标准即光疗。结果A、B组的早期组胆红素峰值(PSB)均低于常规组[A组：(209．48-1-38．99)txmol／L和(266．59±37．11)I,Lmol／L，B组：(180．23±31．63)m0l／，L和(243．68±37．45)~moL／L，P均<0．05]；早期组与常规组相比黄疸消退日龄早[A组：(14．5±4．4)d和(18．0±3．8)d，B组：(10．8±3．0)d和(18．84-5．5)d，P均<0．05l，脂肪乳起始日龄早[A组：(5．8±2．7)d和(8．1±3．7)d，P>0．05；B组：(3．8±1．8)d和(9．2±4．4)d，P<0．05]，恢复出生体质量日龄早[A组：(13．14-6．0)d和(14．4±4．0)d，P>0．05；B组：(9．3±4．8)d和(15．4±5．6)d，P<0．05]。结论早期干预可以使早产儿尤其是极低出生体重儿PSB降低，黄疸持续时间缩短，利于早期添加脂肪乳和早产儿体质量增长。【关键词】黄疽；干预性研究；临床方案EfectsofearlytreatmentonjaundiceinprematureinfantsLIUYing，PIAOMei-hua．PekingUniversityThirdHospital，Beijing100083，ChinaCorrespondingauthor：PIAOMei—hua，Email：pmh1990@sina．com【Abstract】objectiveToinvestigatetheclinicaleffectsofearlyphototherapyofjaundiceinprematureinfantsanditsinfluenceonparenteralnutritionandweightgain．Methods87prematureinfantswithbirth—weightbetween1500—2000g(groupA)and87prematureinfantswithbirth—weightlessthan1500g(groupB)wereenrolledintothestudy．Ineachgroup，subjectsweredividedintotwosubgroups，i．e．conventionaltreatmentgroup，withthetreatmentconductedaccordingtotherecommendedguidelinesoftreatmentforneonataljaundicewhichwasconstitutedin2000；andtheearlytreatmentgroup，withtreatmentearlierthantheaboverecommendedguidelines．ComparisonsweremadebetweensubgroupsinAandBgroups．SPSS11．0softwarewasusedforstatisticalanalysisofdata．ResultsPeakserumbilirubin(PSB)levelinearlytreatmentgroupwassignificantlyhigherthanthatinconventionaltreatmentgroupbothingroupAandB[(209．48±38．99)m0l／，Land(266．59±37．11)mol／／LingroupA，P<0．05；(180．234-31．64)mol／／Lvs(243．68±37．45)~moVLingroupB，P<0．05]．Thetimeofjaundicedisappearinginearlytreatmentgroupwassignificantlyearlierthanthatinconventionaltreatmentgroup，bothingroupAandB[(14．5±4．4)days(18．0±3．8)daysingroupA，P<0．05；(10．8±3．0)daysvs(18．8±5．5)daysingroupB，P<0．05]．Meanwhile，theearlytreatmentgroupcommencedintravenouslipidearlierthanthatoftheconventionaltreatmentgroup[(5．8±2．7)daysus(8．1±3．7)daysingroupA，P>0．05；(3．8±1．8)daysvs(9．2±4．4)daysingroup作者单位：100083北京大学第三医院儿科(刘颖现工作单位：北京大学深圳医院儿科)通讯作者：朴梅花，电子信箱：pmh1990@sina．con中国新生儿科杂志2008年第23卷第6期·337·B，P<0．05)]．Thenewbornsinearlytreatmentgroupregainedtheirbirthweightearlierthanthatoftheconventionaltreatmentgroup[(13．14-6．0)days／)S(14．44-4．0)daysingroupA，P>0．05；(9．34-4．8)daysUS(15．44-5．6)daysingroupB，P<0．05)]．ConclusionIftheprematureinfantsweretreatedwithphototherapyearlier，theywouldbehavingalowerlevelofPSB，andashorterdurationofjaundice，thusbenefitingtheparenteralnutritionandtheweightgain．【Keywords】Jaundice；Interventionstudies；Clinicalprotocols近20年，早产儿尤其是极低生体重儿(VLB．WI)的存活率大大增加，但其神经发育异常的发生率颇高。高...