早产儿光疗后低钙血症原因的探讨

目的探讨蓝光治疗早产儿高胆红素血症对血清钙的影响。方法将82例新生儿高胆红素血症患儿按胎龄分为足月儿及早产儿两组,足月儿47例,早产儿35例,测定光疗前后血清钙水平,比较两组低钙血症的发生率。结果足月儿和早产儿光疗后血清总钙和游离钙均下降(P均<0.01),早产儿低钙血症的发生率为63.0%,足月儿为25.5%,两组比较有显著性差异(P<0.01)。结论早产儿接受光疗时比足月儿更易发生低钙血症,光疗时应监测血钙浓度,胎龄<34周的早产儿宜常规补钙。     

早期预防性光疗对早产儿高胆红素血症的干预

目的: 评价早期预防性光疗干预对早产儿黄疸的影响。方法: 对2004~2005年出生后24h内入院的39例早产儿(干预组),无论有无黄疸都进行预防性光疗,测定血清胆红素并观察其峰值,与2001年11月~2003年11月出生后24h内入院的41例未进行早期预防性光疗的早产儿(对照组)高胆红素血症发生率和血清胆红素峰值进行比较。结果: 干预组和对照组高胆红素血症发生率分别为10.26%和51.22%,差异有统计学意义(P<0.005);干预组血清胆红素峰值(148.1±50.5)μmol/L显著低于对照组(222.2±62.5)μmol/L (P<0.001)。结论: 对生后24h内的早产儿早期进行预防性光疗可防止高胆红素血症的发生。     

早期护理干预对早产儿黄疸影响的研究

目的探讨早期实施护理干预对早产儿黄疸影响。方法选择我院妇产科出生的早产儿108例,按出生顺序随机分为A组（单纯按摩）、B组（单纯灌肠）、C组（按摩灌肠）和D组（对照组）4组（每组各27例）。4组早产儿均进行常规护理及蓝光治疗。通过采用按摩、灌肠以及按摩＋灌肠等干预措施,观察黄疸持续天数、光疗天数、高胆红素血症发生率和2周内黄疸消退情况。结果按摩灌肠组与单纯按摩组、单纯灌肠组和对照组分别比较,黄疸持续天数、光疗天数、高胆红素血症发生率均有减少（P〈0.05）。结论早期实施按摩灌肠等护理干预能降低早产儿黄疸程度,减少高胆红素血症的发生。     

换血治疗与强光源治疗新生儿高胆红素血症疗效比较

  目的  比较换血治疗合并强光源光疗及单纯强光源光疗并发症的不同及住院时间的差别。  方法  回顾性分析121例足月新生儿高胆红素血症病例，比较换血合并使用强光源光疗组患儿及单纯用强光源光疗组患儿并发症的发生率及住院时间，以及球浆比1:1含枸橼酸盐抗凝剂的红细胞和新鲜冻存血浆换血组与球浆比2:1含枸橼酸盐抗凝剂的红细胞和新鲜冻存血浆换血组患儿贫血发生率。  结果  换血合并使用强光源光疗组患儿并发症的发生率高于单纯强光源光疗组患儿并发症的发生率，差异有统计学意义（P < 0.05），而两组患儿住院时间无统计学意义（P > 0.05）；换血组中比较1:1换血组比2:1换血组贫血发生率高，差异有统计学意义（P < 0.05）。  结论  达到换血指标的新生儿高胆红素血症患儿均应考虑先光疗4～6 h并复测血清总胆红素水平，并再次评估是否需要换血治疗，以减少并发症的发生，如采用换血疗法，建议采用2:1换血。     

A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care

OBJECTIVE: To examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia. DESIGN: Follow-up study over 3 years. SETTING: Seven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory. PARTICIPANTS: 137 Aboriginal people with type 2 diabetes. INTERVENTION: Implementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback. MAIN OUTCOME MEASURES: Trends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA(1c)) were achieved; health staff perceptions of barriers to effective service delivery. RESULTS: An initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA(1c) level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients' acceptance of services. CONCLUSIONS: Multifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers and researchers.     

高胆红素血症新生儿光疗中不同部位经皮胆红素测定水平的比较研究

目的比较研究高胆红素血症新生儿光疗中不同部位经皮胆红素的测定水平。方法对100例高胆红素血症接受光疗的新生儿,在每次光疗前、光疗结束时、光疗结束后12 h测定其常规部位（前额正中）和遮盖部位（前额眉心）的经皮胆红素水平,并比较两部位不同时间点胆红素水平的变化。结果光疗前和光疗后12 h常规部位和遮盖部位经皮胆红素水平无显著性差异（P〉0.05）,而光疗结束时遮盖部位的经皮胆红素水平显著高于常规部位（P〈0.05）。结论采用经皮胆红素检测高胆红素血症患儿的光疗效果时,应同时检测暴露部位和遮盖部位的胆红素值加以综合分析。     

二种不同光疗方式治疗新生儿高胆红素血症疗效的比较

目的:观察比较二种光疗方式的疗效和光疗副作用。方法:选择6 0例新生儿高胆红素血症符合光疗指征的患儿分两组,Ⅰ组使用双面蓝光治疗,Ⅱ组使用蓝光床进行光疗。观察胆红素的变化及有关副作用。结果:光疗前两组间的总胆红素和间接胆红素均无显著差异,光疗后两组间的总胆红素和间接胆红素均有显著差异,P <0 .0 1;二组内的光疗前后总胆红素和间接胆红素对比均有显著降低,P值均小于0 .0 1。Ⅰ组和Ⅱ组2 4小时间接胆红素下降率分别是2 9.30 %和2 0 .6 9% ,对比有显著差异;光疗副作用Ⅰ组多于Ⅱ组。.结论:双面蓝光的光疗效果优于蓝光床光疗的疗效,但副作用也大。应根据不同情况选择光疗方式。     

Improving benzodiazepine prescribing in family practice through review and education

Indications for and dosages of four commonly prescribed benzodiazepines were recorded at a family medicine centre with the aid of a computerized data collection system. Four guidelines were then developed for appropriate prescribing of these drugs: (a) benzodiazepines should be used less frequently with increasing age; (b) short-acting drugs are preferable to long-acting drugs; (c) patients 65 years of age and over should receive half the daily dose prescribed for younger patients; and (d) use of these drugs for more than 1 month should be discouraged. After a year's observation it was evident that none of the guidelines were being followed. The 30 physicians in the practice were then informed of the findings by an educational program. Another 6 months of observation showed a reduction in the prescribing of benzodiazepines to patients 65 years of age and over, a significant shift to the use of short-acting benzodiazepines, and some reduction in the daily dose and duration of administration of diazepam. Thus, such a review of drug prescribing in family practice can be a practical and effective method of improving prescribing patterns.     

新生儿高胆红素血症58例临床分析

目的: 观察新生儿高胆红素血症常见病因,探讨妈咪爱(枯草杆菌、肠球菌二联活菌多维颗粒剂)联合能量合剂辅助治疗新生儿高胆红素血症的疗效。方法: 将58例新生儿高胆红素血症随机分成两组,治疗组33例,对照组25例。两组均给予苯巴比妥、光照治疗,治疗组加用妈咪爱及能量合剂治疗。观察两组黄疸消退时间及平均住院时间。结果: 治疗组有效率90.9%高于对照组的76.0%(P<0.05)。治疗组黄疸消退时间为(4.18±1.41)天,短于对照组(5.76±3.78)天(P<0.05);治疗组住院(8.50±1.52)天,短于对照组(10.35±2.73)天(P<0.01)。结论: 妈咪爱联合能量合剂治疗新生儿高胆红素血症,可加快黄疸消退,缩短住院时间,临床应用安全、有效。     

新生儿高未结合胆红素血症蓝光照射治疗时效关系的研究

目的探索新生儿高未结合胆红素血症蓝光治疗期间和停止治疗后经皮胆红素（TcB）值变化的时效关系。方法 90例非溶血高未结合胆红素血症新生儿按日龄≤7d和〉7d分为A、B组,用固定光疗装置进行蓝光治疗,24 h治疗期间及24h休息期内每2 h测定TcB值,对所测值进行绘图和统计学处理。结果连续光疗24 h后A、B组TcB下降均值分别为（142±63）μmol/L、（174±24）μmol/L,与治疗前比较,皆下降明显（P〈0.01）,但组间比较差异无统计学意义（P〉0.05）;A组在光疗第12小时、B组在光疗第10小时后TcB显著下降（P〈0.05）。停止光疗后24 h休息期,A、B组TcB值回升均值分别为（114±61）μmol/L、（51±22）μmol/L,差异有统计学意义（P〈0.05）,而B组14h后TCB值上升不明显（P〉0.05）。结论蓝光治疗非溶血新生儿高未结合胆红素血症疗效显著,且有一定时效性。     

中西医结合治疗新生儿高未结合胆红素血症

目的 评价肠道微生态调节剂培菲康和中成药消炎利胆片联合治疗新生儿高未结合胆红素血症伴不同程度胆汁 淤积的疗效。方法 １１６例新生儿高未结合胆红素血症患儿随机分成 ３组,对照组 ４２例采取常规治疗,培菲康组 ２０例 采取常规治疗＋培菲康,联合组５４例采取常规治疗＋培菲康和消炎利胆片,观察３组血清胆红素、胆汁酸日均下降值 和治愈所用天数。结果两治疗组血清胆红素、胆汁酸日均下降值均明显高于对照组,治愈所用天数均明显低于对照组 （Ｐ＜０．００１）;联合治疗组疗效优于培菲康组（Ｐ＜０．０５）。结论培菲康和消炎利胆片联合应用治疗新生儿高未结合胆红素 血症较单独使用培菲康具有更好疗效,值得推广。     

蓝光、鲁米那、茵桅黄治疗新生儿高胆红素血症的价值探讨

目的 探讨蓝光治疗新生儿高胆红素血症的价值及加用鲁米那或茵桅黄对新生儿高胆红素血症的治疗价值。方法 1998—2001年我科住院治疗的新生儿高胆红素血症患儿，按治疗方案不同分为4组(蓝光治疗组、蓝光 鲁米那组、蓝光 茵桅黄组、蓝光 鲁米那 茵桅黄组)，比较4组患儿的黄疸消退时间、平均每天血清胆红素下降值。结果 4组患儿的黄疸消退时间，平均每天血清胆红素下降值间的差别均无显著性意义（P＞0．05)。结论 蓝光治疗新生儿高胆红素血症是有效的，加用鲁米那或茵桅黄对新生儿高胆红素血症的疗效无明确增强作用。     

Contemporary practice patterns in the management of newly diagnosed hypertension

OBJECTIVE: To determine what proportion of patients with hypertension are managed in accordance with guidelines established by the Canadian Hypertension Society. DESIGN: Retrospective medical record review. SETTING: Outpatients seen in primary care offices and internal medicine referral clinics in Edmonton. PATIENTS: All 969 adults who presented with a new diagnosis of essential hypertension from Sept. 1, 1993, to Dec. 31, 1995. OUTCOME MEASURES: Initial laboratory tests performed, advice concerning nonpharmacologic treatment given, antihypertensive drugs prescribed and any contraindications to thiazide diuretics or beta-adrenergic blocking agents documented. RESULTS: The mean age of the 969 patients in the sample was 52.5 years; 129 (13%) of the patients were older than 70 years of age; and 500 (52%) were women. Most of the patients (704, 73%) had mild or moderate diastolic hypertension. In the 617 patients who underwent laboratory tests related to hypertension, the creatinine level was determined in 466 (76%), the cholesterol level in 372 (60%), a urinalysis was conducted in 378 (61%), the serum potassium level was checked in 343 (56%), the sodium level in 323 (52%) and an electrocardiogram was performed in 303 (49%). Liver function tests, which are not recommended in the guidelines, were performed in 338 patients (55%). Although there were differences in prescribing among physicians in the 711 patients given first-line therapy, most (238, 34%) were prescribed angiotensin-converting-enzyme (ACE) inhibitors. Lifestyle modification, without drug therapy, was suggested for 180 (25%) of the patients. Although the guidelines recommend their use for first-line drug therapy, only 82 patients (12%) were given beta-adrenergic blocking agents and only 75 (11%) were given thiazide diuretics. Of the patients who were prescribed an antihypertensive other than a thiazide or beta-adrenergic blocking agent as first-line drug therapy, only 161 (43%) had a documented contraindication to thiazides or beta-adrenergic blocking agents. CONCLUSIONS: There is variation in the contemporary care of patients with hypertension. Further studies are required to determine the reasons underlying physicians' noncompliance with the evidence-based guidelines established by the Canadian Hypertension Society.     

不同光疗方式时新生儿高间接胆红素血症血清IL-2、IL-10水平的变化及其意义

目的探讨不同光疗方式时新生儿高间接胆红素血症血清IL-2、IL-10水平的变化及其意义。方法选择48例足月高间接胆红素血症新生儿为研究对象,按序贯试验分为持续光疗组24例(光疗24 h停24 h)、间断光疗组24例(光疗12 h停12 h×2 d),均于光疗前、光疗后24 h和48 h分别检测血清总胆红素、间接胆红素浓度,采用酶联免疫分析(ELISA)法检测血清IL-2、IL-10水平。结果 1)2组光疗后血清总胆红素、间接胆红素浓度均明显降低;光疗后24 h持续光疗组血清总胆红素、间接胆红素浓度明显低于间断光疗组(P<0.01),光疗后48 h血清总胆红素、间接胆红素浓度2组间比较差异无统计学意义(P>0.05)。2)2组光疗后血清IL-2水平均明显上升;光疗后24 h持续光疗组血清IL-2水平明显高于间断光疗组(P<0.01),光疗后48 h血清IL-2水平2组间比较差异无统计学意义(P>0.05)。3)持续光疗组光疗后24、48 h血清IL-10水平均较光疗前上升(P<0.001),光疗后48 h与24 h比较差异无统计学意义(P>0.05);间断光疗组光疗前后血清IL-10水平无明显变化(P>0.05...     

改良双面光疗箱对高胆红素血症新生儿的退黄效果

目的 观察双面光疗箱内使用银色反光材料对新生儿高胆红素血症的退黄效果。方法 将2013年6~8月安徽省儿童医院62例临床诊断为新生儿高胆红素血症的患儿按入院顺序编号,设奇数为干预组,偶数为对照组。干预组31例,使用改良的双面光疗箱进行蓝光照射;对照组31例,使用普通新生儿双面光疗箱蓝光照射。比较两组患儿在光疗前及光疗8小时、12小时及24小时的经皮胆红素值;同时观察光疗对两组患儿的副作用。结果 两组患儿光疗前经皮胆红素测定值比较,差异无统计学意义(P>0.05);光疗8小时后干预组经皮胆红素测定值下降优于对照组,差异有统计学意义(P<0.05);两组患儿光疗期间出现的副作用相比较,差异无统计学意义(P>0.05)。结论 改良的双面光疗箱较普通光疗箱,能更有效降低胆红素水平,退黄效果明显。     

Serum bilirubin levels in breast- and formula-fed infants in the first 5 days of life.

A prospective study was conducted in a level II maternity unit to investigate the incidence of hyperbilirubinemia in healthy, term, breast-fed and formula-fed infants. Serum bilirubin levels were determined for 176 breast-red and 164 formula-fed infants in cord blood and on days 1, 2, 3 and 5 after birth. The mean total bilirubin levels were significantly higher on each postnatal day in the breast-fed infants, as was the proportion of infants with peak levels above 12 mg/dl (205 mumol/l; 28% v. 6%). The breast-fed infants also had significantly higher proportional weight losses on each postnatal day than the formula-fed infants. However, there was no correlation between the cumulative weight loss on day 3 and bilirubin levels on the same day with either feeding regimen. None of the infants required an exchange transfusion or prolonged care in hospital for hyperbilirubinemia.     

Intensive phototherapy vs. exchange transfusion for the treatment of neonatal hyperbilirubinemia: a multicenter retrospective cohort study

Background: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia.Methods: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that ...     

G6PD缺陷症对新生儿高胆红素血症病程的影响

目的探讨G6PD缺陷症对新生儿高胆红素血症病程的影响。方法确诊高胆红素血症新生儿77例,分为两组:G6PD缺陷症组37例,G6PD正常组40例。全部病例均给予双面蓝光光疗,对比两组新生儿治疗前血清总胆红素(Total serum bilirubin,TSB)、血红蛋白和治疗后TSB、血红蛋白、总光疗时间、住院天数。结果 G6PD缺陷症组和G6PD正常组新生儿治疗前TSB分别为(278.43±15.26)μmol/L和(276.68±12.15)μmol/L(P>0.05),血红蛋白分别为(165.58±10.90)g/L和(160.95±9.76)g/L(P>0.05)。G6PD缺陷症组和G6PD正常组新生儿治疗后TSB分别为(168.70±9.79)μmol/L和(162.68±12.09)μmol/L(P<0.05),血红蛋白分别为(150.59±7.82)g/L和(153.63±7.80)g/L(P>0.05)。G6PD缺陷症组和G6PD正常组新生儿总光疗时间分别为(65.51±16.87)h和(45.00±12.67)h(P<0.01),住院天数分别为(7.22±1.60)d和(5.58±1.45)d(P<0.01)。结论 G6PD缺陷症新生儿虽无明显溶血发生,但G6PD缺乏也会延缓高胆红素血症的消退,增加光疗时间和住院天数。