光疗后新生儿经皮胆红素测定值与血清胆红素值数学模型研究

摘要

目的：通过建立光疗结束时遮光材料覆盖区域新生儿经皮胆红素测定值(TcB)与血清胆红素值(TSB)关系的数学模型，为临床用新生儿经皮胆红素测定值来推算实际血清胆红素值提供理论依据。方法2013年10月—2014年6月期间随机选择温州医科大学附属乐清医院新生儿科住院的病理性黄疸患儿，根据胎龄分为：足月儿组(胎龄≥37周)、晚期早产儿组(胎龄34~36+6周)和早中期早产儿组(28~33+6周)。给予单面或双面光疗，光疗时在额部、前胸部经皮胆红素检测区域用遮光材料覆盖，光疗前后测定额部、前胸部、会阴部TcB各3次，同时抽血检测TSB。结果共261例患儿纳入研究，足月儿组169例、晚期早产儿组63例、早中期早产儿组29例。光疗前，所有病例额部、前胸部、会阴部TcB值与TSB值均有显著相关性(r=0.813、0.827、0.754，P均<0.001)，其中前胸部TcB值与TSB值相关性最好，因此光疗前采用新生儿前胸部TcB值与TSB值建立直线回归方程：TSB=1.35 TcB –5.50。光疗结束时，所有病例额部、前胸部、会阴部TcB值与TSB值也均有显著相关性(r=0.751、0.807、0.683，P均<0.001)，其中前胸部TcB值与TSB值相关性最好，因此光疗后采用前胸部TcB值与TSB值建立直线回归方程：TSB=1.01×TcB –0.62。三组中，足月儿组较其他组相关性更佳。结论光疗结束后前胸部黑色卡纸遮盖区域的TcB值与TSB值相关性好，可以建立直线回归模型。%ObjectiveTo establish the mathematical model of transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) after phototherapy in neonates.MethodsNeonates with pathological jaundice were enrolled from October 2013 to June 2014. The neonates were divided into three groups by gestational age: full-term neonates (gestation age of 37-42 weeks), late preterm neonates (gestation age of 34-36+6 weeks), early and mid-preterm neonates (gestation age of 28-33+6 weeks). The neonates received single or double sided phototherapy. During the phototherapy, the forehead and chest were covered by opaque material. The TcB was measured at forehead, mid sternum, perineum area three times each before and after phototherapy. Mean-while the TSB was tested.Results Two hundred and sixty-one neonates with hyperbilirubinemia were enrolled, among whom there were 169 full-term neonates, 63 late preterm neonates and 29 early and mid-preterm neonates. Before phototherapy, there were signiifcantly correlation of TSB with TcB on forehead, mid sternum and perineum (r=0.813, 0.827, 0.754;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.35TcB-5.50. After phototherapy, there were signiifcantly correlateion of TSB with TcB on forehead, mid sternum, and perineum (r=0.751, 0.807, 0.683;P<0.001) and the best correlation was with TcB on mid sternum. The linear regression equation was TSB=1.01×TcB-0.62. Among three groups, the full-term neonates had the best correlation.ConclusionsAfter phototherapy, the TcB measured on mid sternum which was covered by opaque material is well correlated with TSB. The linear regression model can be established.