新生儿光疗前后不同部位经皮胆红素测定值的准确性研究  

The reliability of transcutaneous bilirubin measurements at different sites before and after phototherapy compared with total serum bilirubin in neonates

作　　者：赵丹丹[1] 李敏[1] 高翔羽[1] 黄迪[1] 杨波[1] 任漪[1] 王静[1] 

机构地区：[1]南京中医药大学附属徐州市中心医院儿童诊疗中心新生儿科,221009

出　　处：《中华新生儿科杂志（中英文）》2017年第5期351-356,共6页Chinese Journal of Neonatology

摘　　要：目的 探讨光疗前后前胸（遮盖及未遮盖）、眉心、肩胛部位经皮胆红素（transcutaneousbilirubin,TcB）值与同期血清胆红素（total serum bilirubin,TSB）值相比的准确性.方法 选择2015年9月至2016年7月我院新生儿科收治、因病情需检测血生化（包括TSB值）,且前胸部位连测3次TcB均值＞6 mg/dl的新生儿.入选新生儿均取静脉/动脉血检测TSB,并在0.5h内采用JH20-1C型经皮黄疸仪测定前胸、眉心、肩胛部位的TcB值.新生儿光疗时遮盖左胸直径2 cm范围,光疗停止后0h、12 ～24 h测定TSB值,并在测定TSB0.5h内测定左胸遮盖、右胸、眉心、肩胛部位的TcB.应用SPSS 20.0统计软件,采用相关分析、方差分析、一致性分析及t检验对数据进行分析.结果 共纳入364例新生儿,光疗前得到437组数据.不同部位TcB值与TSB值均有较好的相关性及一致性（P＜0.05）,TSB与前胸TcB差值最小,为（-1.2±2.3）mg/dl.光疗停止后0h（193组数据）及12～24 h（175组数据）左胸遮盖部位TcB与TSB的相关性及一致性最佳,TSB与左胸遮盖部位TcB差值最小,分别为（-0.3±1.5）、（-0.5±1.6）mg/dl.光疗前,TSB≥15 mg/dl时TSB与前胸＇FeB差值为（1.5±1.6） mg/dl,TSB＜ 15 mg/dl时TSB与前胸TcB差值为（-1.9±1.9）mg/dl,差异有统计学意义（P＜0.001）.TSB与前胸TcB差值不受性别、胎龄、出生体重、测定时龄及重复测量影响.当前胸TcB值低于光疗TSB界值3.3 mg/dl以上、左胸遮盖部位TcB值低于停止光疗TSB界值2.6 mg/dl以上时,97.5％的新生儿TSB值不会超过相应界值.结论 光疗前,前胸TcB相对最准确;光疗后,左胸遮盖部位TcB最准确,可替代TSB用于新生儿黄疸的评估与管理.Objective To evaluate the accuracy of the transcutaneous bilirubin （TcB） at different sites including the chest （covered and uncovered）,forehead and scapula,compared with total serum bilirubin （TSB） before and after phototherapy.Method Neonates who underwent blood test of TSB together with the average TcB at chest over 6 mg/dl from September 2015 to July 2016 in our Hospital were enrolled in our study.TcB measurements were done by the transcutaneous bilirubinometer （JH20-1 C） at the sites of the chest,forehead and scapula within 30 minutes after venous or arterious blood sampling for testing TSB after admission.An area of 2 cm diameter over the left chest was covered during phototherpy.TSB was tested immediately and within 12 ～ 24 hours after phototherapy,while TcB was measured within 0.5 hour after blood sampling at the covered sites over the left chest,right chest,forehead and scapula.IBM SPSS 20.0 software was used for data analysis.Data were compared via Pearson correlation analysis,ANOVA of repeated measurement data,student＇s t test and Bland-Altman analysis.Result A total of 437 data were collected from 364 neonates were enrolled in our study.Before phototherapy,the values of TcB at different sites were highly correlated and consistent with TSB （P 〈 0.05）,especially taken from the chest （the difference value of TcB and TSB-1.2 ± 2.3 mg/dl）.Immediately and within 12 ～ 24 hours after the phototherapy,the values of TSB and TcB taken from the covered left chest showed the highest consistency （-1.2±2.3 mg/dl and-0.5 ± 1.6 mg/dl）.When TSB exceeded 15 mg/dl before phototherapy,the difference between TSB and TcB taken from chest was 1.5 ± 1.6 mg/dl,while if TSB was below 15 mg/dl,the difference was-1.9 ± 1.9 mg/dl.They were significantly different （P 〈 0.001）.And difference between TSB and TcB taken from chest was not affected by gender gestational age,birth weight,days of birth and different measurements.When TcB taken from the covered or uncovered chest was less than

关 键 词：胆红素 黄疸 新生儿 光疗法 经皮胆红素 血清胆红素 

分 类 号：R722.1[医药卫生—儿科]