间断及持续蓝光照射治疗不同病因新生儿黄疸的疗效与安全性分析

目的：比较间断及持续蓝光照射联合枯草杆菌二联活菌颗粒治疗新生儿黄疸的疗效与安全性，指导临床安全、有效治疗新生儿黄疸。方法：选取120例符合入选标准的新生儿高胆红素血症患儿作为研究对象，分析病因及临床特点，按随机数字表法分为I组60例和Ⅱ组60例，I组给予间断蓝光照射联合枯草杆菌二联活茵颗粒治疗，Ⅱ组给予持续蓝光照射联合枯草杆菌二联活茵颗粒治疗，5d为1个疗程，治疗1个疗程后观察患儿症状改善情况，检测血清胆红素及粪胆素水平变化情况，计算第1天胆红素下降值、日均胆红素下降值及黄疸持续时间，评价临床疗效，记录治疗过程中出现的不良反应。结果：（1）新生儿黄疸以围产因素与母乳性黄疸为主，二者约占62．5％；（2）I组和Ⅱ组治疗5d后临床有效率分别为93．3％、95．0％，两组比较差异无统计意义（x2=0．37，P〉0．05）；（3）治疗后I组和Ⅱ组的血清胆红素水平均较治疗前明显下降（P〈0．01），粪胆素均较治疗前明显提高（P〈0．01），但两组患儿治疗后胆红素和粪胆素水平比较差异无统计学意义（P〉0．05）；（4）I组和Ⅱ组黄疸持续时间、第1天胆红素下降值、日均胆红素下降值、首次排胎粪时间、胎粪排净时间比较差异无统计学意义（P〉0．05）；（5）I组和Ⅱ组患儿的不良反应发生率分别为18．33％、56．67％，两组比较差异有统计学意义（x2=21．37，P〈0．01）。结论：新生儿黄疸的主要病因是围产因素与母乳性黄疸，间断蓝光照射联合枯草杆菌二联活茵颗粒能够促进新生儿黄疸胆红素分解与代谢，缩短病程，预防并发症发生，且具有比持续蓝光照射更好的安全性，值得临床推广应用。

Comparison of Efficacy and Safety of Intermittent Blue Light Irradiation and Continuous Blue Light Irradiation in the Treatment of Neonatal Jaundice with Different Causes

Objective： To compare efficacy and safety of intermittent blue light irradiation and continuous blue light irradiation combined with Medilac-Vita in the treatment of neonatal jaundice with different causes, and to guide clinical treatment safely and effectively. Methods： One hundred and twenty cases with neonatal jaundice met inclusion criteria were included as the research objects, and analyzed cause features of neonatal jaundice. They were randomly divided into two groups, sixty cases of each group. Group I was given intermittent blue light irradiation and Medilac-Vita, while group II was given continuous intermittent blue light irradiation and Medilac-Vita. The course of treatment was five days. The improvement of symptoms after a course of treatment was observed. Serum bilirubin and fecal bile pigment were detected. The decline of bilirubin on the first day, the average daily decline of bilirubin and the disappearance time of jaundice were calculated. The clinical effect was evaluated, and the adverse events during treatment were recorded. Results： The main types of neonatal jaundice were perinatal factors and breast milk jaundice, and both types accounted for 62.5%. （~） The clinical total effective rate of group I and group lI were 93.3% vs 95.0% after treatment for five days; the difference was not statistically significant （X： =0.37, P〉0.05）. Serum bilirubin of group I and group II after treatment were significantly lower than those before treatment; fecal bile pigment were significantly higher than that before treatment （P〈0.01） ; there were no significant difference between both groups before and after treatment. The disappearance time of jaundice, the decline of bilirubin on the first day, the average daily decline of bilirubin, the time of passage of first meconium and the complete time of meconium discharge of both groups had no significant difference. （~） Adverse reaction rates of group I and group I1 were 18.33% vs 56.67% ; the difference was statistically significant （X2 =21.37, P〈0. O1 ）. Conclusions： The main causes of neonatal jaundice are perinatal factors and breast milk jaundice. Intermittent blue light irradiation and Medilac-Vita can promote decomposition and metabolism of bilirubin, shorten the course, and prevent complications. The therapy is safe and worthy of clinical use in the treatment of neonatal jaundice with different causes.