新生儿缺氧缺血性脑病最佳干预时间窗的研究  

Study of the best intervention time window in neonatal hypoxic-ischemic encephalopathy

作　　者：李卫东[1] 蔡志豪[1] 简赵芳[1] 王文祥[1] 

机构地区：[1]南方医科大学附属小榄医院儿科,广东中山528415

出　　处：《广州医药》2013年第5期12-14,共3页Guangzhou Medical Journal

摘　　要：目的研究采用不同的时间窗治疗新生儿缺氧缺血性脑病（HIE），可能对神经系统的预后产生差异，从而为减少其神经系统后遗症的发生提供理论与临床依据。方法采用回顾性分析，对我院新生儿科于2007年1月-2010年12月收治的中度及重度新生儿缺氧缺血性脑病患儿156例作为研究对象，根据其出生后入院时间分为对照组与试验组。对照组为出生后24～72小时入院38例；试验组为24小时内入院118例，再分2个亚组，A组（出生～6小时内入院）73例。B组（6～24小时内入院）45例。所有病例诊断均符合新生儿缺氧缺血性脑病中度及重度诊断标准。入院后每组患儿均给予相同的治疗，且在出生1周岁内均给予不同程度及类型的早期康复干预。所有患儿出院后均于3、6、9、12月龄在我院儿童保健门诊，使用中国标准化的贝来量表（CDCC）测智力发育指数（MDI）和运动发育指数（PDI）。结果3、6、9、12月时A组MDI、PDI高于对照组（24～72小时入院），差异有统计学意义。而B组MDI、PDI和对照组比较，差异无统计学意义。结论采用相同的干预治疗措施下，不同时间窗开始治疗新生儿缺氧缺血性脑病的预后存在明显差异，出生6小时内开始治疗的患儿其预后明显优于6小时后开始治疗的患儿。提示新生儿缺氧缺血性脑病临床最佳治疗时间窗可能为6小时。Objective To study the optinal time windows in the treatment of neonatal hypoxic-ischemic encephalopathy （HIE） . Methods A retrospective analysis was used. 156 cases with moderate or severe neonatal hypoxic-ischemic encepha- lopathy in our hospital from January 2007 to December 2010 were selected. According to their admission time they were divided into the control group and the experimental group. There were 38 cases in the control group （ admission between 24 - 72 hours af- ter birth）, and there were 118 cases in the experimental group （ admission within 24 hours after birth） . The experimental group was subdivided into two sub-groups, group A （less than 6 hours after birth） has 73 cases; and group B （6 to 24 hours after birth） has 45 cases. All of the cases met the diagnostic criteria of moderate and sever HIE. Each gronp received the same inter- vention therapy during hospitalization. All were given different levels and types of early rehabilitation intervention before 1 year. All of them were followed up at the age of 3 months, 6 months, 9 months and 12months tbr evaluation of Mental Development In- dex （MDI） and Psychomotor Development Index （PDI） designed by the standardization Child Development Center of China （CDCC） . Results The MDI and PDI of group A were higher, and there was statistical significance between them. But there was no statistical significance between group B and the control group. Conclusion Using the same therapeutic intervention measures, different time windows began in treatment of neonatal hypoxic ischemic encephalopathy prognosis in the presence of significant difference. Prognosis for children born within six hours of the start of treatment was significantly better than six hours after the start of treatment. It showed for neonatal hypoxic ischemic encephalopathy optimal therapeutic time window may be 6 hours.

关 键 词：新生儿 缺氧缺血脑 早期干预 预后 

分 类 号：R473.72[医药卫生—护理学]