重症新生儿高胆红素血症急性期神经保护剂及早期干预联应用的临床研究  

Clinical Study on Joint Use of Neuroprotectant and Early Intervention in the Neonates with Severe Hyperbilirubinemia

作　　者：金冬梅[1] 陈国萍[1] 米延[1] 张卓伯[2] 

机构地区：[1]哈尔滨医科大学附属第一医院儿科,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第四医院神经内科,黑龙江哈尔滨150001

出　　处：《华西医学》2009年第8期2000-2003,共4页West China Medical Journal

基　　金：黑龙江省卫生厅2007科研基金项目(编号:2007214)

摘　　要：目的：观察神经保护剂及早期干预联合应用对重症新生儿高胆红素血症神经行为预后的影响。方法：将2007年1月至2008年6月收治重症新生儿高胆红素血症患儿67例随机分为常规治疗组和综合治疗组2组。常规治疗组按照新生儿黄疸干预推荐方案,给与对症治疗;药物治疗;蓝光治疗;周围血管法同步换血等常规治疗。综合治疗组在常规治疗基础上,同时给与新生儿抚触1天2次和神经保护剂神经节苷脂20 mg/d×10天,并在经抢救治疗进入恢复期后,按照《0-3岁早期干预大纲》采用医院和家庭相结合的方式从视,听,触,运动等各方面给予早期干预至6月龄。两组患儿均在6月龄采用北京-Gesell婴幼儿发育诊断量表进行智能测试,比较各组发育商（DQ）。同时对两组后遗症发生机率比较。结果：患儿6月龄时,综合治疗组与常规治疗组在大运动,语言,个人-社交及适应性4个能区均有显著差异（P〈0.01）,精细动作能区有明显差异（P〈0.05）,差别有统计学意义。综合治疗组与常规治疗组后遗症发生率比较（P〈0.05）,差异有统计学意义。结论：急性期神经保护剂及早期干预联合应用可促进重症新生儿高胆红素血症患儿的智能发育,减少神经行为后遗症的发生。Objective：To investigate the effect of the joint use of neuroprotectant and early intervention on the intelligence of neonates with severe hyperbilirubinemia.Methods：Sixty-seven neonates with severe hyperbilirubinemia were randomly divided into conventional treatment group and comprehensive treatment group.The neonates in conventional treatment group received symptomatic treatment,drug treatment,phototherapy,exchange transfusion by peripheral vessels in accordance with ＂Recommended program for management of neonatal jaundice＂.Besides these,the neonates in comprehensive treatment group were given newborn touch twice a day and GM-1 20 mg/d×10d.When the neonates in comprehensive treatment group were gradually stable,they were given early intervention including seeing,listening,sense impressions,movement by doctors and their parents until they were 6 months following the ＂Clinical guidelines of early intervention for 0-3 years baby＂.The DQ of the babies in both groups was examined with the method of Beijing Gesell Baby Development Test when the babies were 6 months old.The incidence of sequelae was compared in two groups.Results：The babies ability in the comprehensive treatment group were significantly better than those in the conventional treatment group（P 〈 0.01） in four large intelligent area such as limb movement,language,social intercourse,adaptability and also better（P 〈 0.05）in small joint movement intelligent area.The incidence of sequelae was less in comprehensive treatment group compared with conventional treatment group.Conclusion：The joint use of neuroprotectant and early intervention could improve babies＇ intelligence development and decrease sequelae in the neonates with severe hyperbilirubinemia.

关 键 词：重症新生儿高胆红素血症 神经保护剂 早期干预 神经行为预后 

分 类 号：R722.17[医药卫生—儿科] R748[医药卫生—临床医学]