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目的分析新生儿光照疗法中皮肤遮盖部位与暴露部位经皮胆红素测量值与血清总胆红素值的相关性,为临床在光照疗法中选择经皮胆红素测量部位提供参考依据。方法选取2016年1月29日—4月15日收治的112例高间接胆红素血症患儿作为研究对象。选取临床常用的两个皮肤暴露部位及两个遮盖部位作为经皮胆红素的测量部位。在入院时及光照疗法过程中采血监测血清总胆红素值,同时测定暴露部位与遮盖部位的经皮胆红素值。结果在光照疗法中的4个时间点,2个暴露部位的经皮胆红素测量值与血清总胆红素值相比,差异均具有统计学意义(均P<0.01)。遮盖部位中,遮盖的胸骨第二肋正中处皮肤的4次经皮胆红素测量值与血清总胆红素值相比,差异均无统计学意义(均P>0.05)。当血清总胆红素大于307.8μmol/L(18 mg/dl)时,血清总胆红素值均高于经皮胆红素测量值,差异均具有统计学意义(均P<0.01)。结论光照疗法中选择皮肤遮盖部位,尤以选择遮盖的胸骨第二肋正中皮肤测量的经皮胆红素值能更准确反映血清总胆红素水平。当血清总胆红素值大于307.8μmol/L(18 mg/dl)时,经皮胆红素测量值不能准确反映血清总胆红素水平。
Objective To analyze the correlation between transdermal bilirubin and serum total bilirubin in the area of skin cover and exposed area in neonatal phototherapy and to provide a reference for the clinical application of transdermal bilirubin in light therapy. Methods One hundred and twelve children with high indirect hyperbilirubinemia admitted from January 29, 2016 to April 15, 2016 were selected as the study subjects. Select the commonly used clinical two exposed parts of the skin and two covered parts as the measurement of transcutaneous bilirubin. Blood serum was monitored for total bilirubin concentration at admission and during phototherapy, and transdermal bilirubin values were measured at the exposed and covered sites. Results At 4 time points, there were significant differences in the transcutaneous bilirubin between the two exposed sites and the serum total bilirubin (all P <0.01). There was no significant difference in the 4 transdermal bilirubin values in the covered area compared with the total serum bilirubin value (P> 0.05). When serum total bilirubin was greater than 307.8 μmol / L (18 mg / dl), serum total bilirubin value was higher than that of transcutaneous bilirubin, the differences were statistically significant (both P <0.01). Conclusion The choice of skin cover in phototherapy, especially in the selection of the sternal second rib median skin transcutaneous bilirubin value can more accurately reflect the serum total bilirubin levels. When serum total bilirubin is greater than 307.8 μmol / L (18 mg / dl), the transcutaneous bilirubin measurement does not accurately reflect the serum total bilirubin level.