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目的研究经皮胆红素测定结果准确性的影响因素,探讨经皮胆红素监测方法对不同胎龄不同出生体重黄疸新生儿的临床应用价值。方法对160例黄疸新生儿进行前瞻性研究,患儿均为汉族,胎龄28~42周,出生体重750~4 000 g,应用经皮胆红素测定仪分别于目测发现皮肤黄疸时,以及24 h与48 h后监测前额眉心处皮肤胆红素(TcB)水平,同时抽血测定血清胆红素(TsB),对两种测定方法进行比较分析。结果 (1)在胆红素水平、不同胎龄及不同出生体重方面,TcB均与TsB呈正相关(r=0.398~0.832,P<0.05)。胎龄>33周的新生儿TcB与TsB的相关性更好,出生体重大的新生儿TcB与TsB的相关性更好。(2)TcB、TsB分别与监测时间呈正相关,出生体重750~1 500 g和~2 000 g的TsB与监测时间的相关性更好。结论一般情况下TcB可代替TsB进行动态监测。但对早产儿以及(极)低出生体重儿,最好同时检测TsB以进一步明确胆红素值。另外对于<2 000 g的低出生体重儿,用TcB进行动态监测黄疸可能更加准确地反映病情变化。
Objective To study the influencing factors of the accuracy of transcutaneous bilirubin determination and to explore the clinical value of transcutaneous bilirubin monitoring in neonates with different birth weights and jaundice at different gestational ages. Methods 160 cases of neonatal jaundice were prospectively studied. All children were Han nationality. The gestational age ranged from 28 to 42 weeks and the birth weight ranged from 750 to 4 000 g. When transcutaneous bilirubin was used to detect skin jaundice respectively, The levels of TcB in the forehead and eyebrow were measured at 24 h and 48 h, and the serum bilirubin (TsB) was determined by blood sampling. The two methods were compared and analyzed. Results (1) TcB was positively correlated with TsB at bilirubin level, gestational age and birth weight (r = 0.398-0.832, P <0.05). Neonatal TcB at gestational age> 33 weeks had a better correlation with TsB, and neonatal TcB at neonatal weight correlated better with TsB. (2) TcB and TsB were positively correlated with monitoring time, and the correlation between TsB and monitoring time of birth weight of 750-1 500 g and -2000 g was better. Conclusion In general, TcB can be used instead of TsB for dynamic monitoring. However, for preterm and (very) low birth weight infants, it is best to test TsB simultaneously to further clarify the value of bilirubin. In addition, <2 000 g of low birth weight infants, dynamic monitoring with TcB jaundice may be more accurately reflect the changes in the condition.