摘要
目的探讨熊去氧胆酸联合蓝光间歇照射在新生儿黄疸中的疗效及对患儿血清总胆汁酸(TBA)、转铁蛋白(TRF)、总胆红素(TBIL)的影响。方法选择2015年3月～2016年3月航空总医院新生儿科接诊的160例黄疸患儿,随机分为观察组和对照组,每组各80例,两组在常规对症治疗基础上,均使用熊去氧胆酸片口服,观察组给予蓝光间歇照射,每次照射时间3～5h,停止2～4h再次照射,对照组行蓝光持续照射,每次照射时间12～16h,停止8～12h后再次照射,连续治疗4天。比较两组临床疗效、治疗前后心肌酶谱、血清TBA、TRF、TBIL的变化及黄疸消失时间、不良反应发生率。结果治疗后,两组临床疗效总有效率比较差异无统计学意义(P>0.05),两组谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)较治疗前均显著降低(P<0.05),治疗后AST、LDH、CK、CK-MB两组比较差异均无统计学意义(P>0.05),两组血清TBA、TBIL较治疗前均显著降低,TRF显著升高(P<0.05),且两组治疗后血清TBA、TRF、TBIL比较差异无统计学意义(P>0.05);两组黄疸消失时间比较差异无统计学意义(P>0.05);观察组腹泻、皮疹、脱水、食欲减退、发热的总发生率明显低于对照组,差异有统计学意义(P<0.05)。结论熊去氧胆酸分别联合蓝光间歇照射和蓝光持续照射效果相似,均可有效改善血清TBA、TRF、TBIL的表达,促进黄疸消退,但联合蓝光间歇照射不良反应更少,安全性更高,可在临床推广应用。
Objective To study curative efficacy of ursodeoxycholic acid combined with blue light intermittent irradiation in treatment of neonatal jaundice and effects on serum total bile acid(TBA), transferring(TRF), total bilirubin(TBIL). Methods 160 patients of neonatal jaundice received therapy from March 2015 to March 2016 in General Hospital of china Aviation were selected as research objects. According to random number table, those patients were divided into the observation group(n=80) and the control group(n=80). On the basis of routine symptomatic treatment, they took oral the Ursodeoxycholic acid tablets. The observation group was given the blue light intermittent irradiation, each time 3～5 h, stop 2～4 h again. The control group was given the blue light continuous irradiation, each time 12～16 h, stop 8～12 h again, continuous treatment of 4 d. The clinical efficacy, the changes of myocardial enzyme spectrum, serum TBA, TRF and TBIL before and after treatment, jaundice disappearance time and the incidence of adverse reaction were compared between the two groups. Results After treatment, the total effective efficiency of the two groups was 90% and 92.50%, and there was no significant difference(P>0.05). After treatment, the aspartate aminotransferase(AST), lactate dehydrogenase(LDH), creatine kinase(CK), creatine kinase isoenzyme(CK-MB) of the two groups were significantly lower than before treatment(P<0.05). There was no significant difference in AST, LDH, CK and CK-MB after treatment between the two groups(P>0.05). After treatment, the serum TBA and TBIL of the two groups were significantly lower than those before the treatment, and the TRF was significantly increased(P<0.05). There was no significant difference in serum TBA, TRF and TBIL after treatment between the two groups(P>0.05). There was no significant difference in the jaundice disappearance time between the two groups(P>0.05). The total incidence of diarrhea, rash, dehydration, anorexia and fever in the observation group was 11.25%, which was significantly lower than that of the control group 37.50%. The differences were statistically significant(P<0.05). Conclusion The effect of ursodeoxycholic acid combined with blue light intermittent irradiation and blue light continuous irradiation were similar, which could effectively improve the expression of serum TBA, TRF and TBIL, promote the jaundice disappearance. However, combined with blue light intermittent irradiation has less adverse reaction and higher safety.
引文
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