不同复温速度对亚低温治疗新生儿缺氧缺血性脑病的影响  

The preliminary analysis about the effect of different rewarming speed on mild hypothermia therapy for HIE

作　　者：陆镇奇[1] 刘丽君[1] 高平明[1] 

机构地区：[1]佛山市妇幼保健院新生儿科,广东佛山528000

出　　处：《分子影像学杂志》2016年第3期241-244,共4页Journal of Molecular Imaging

摘　　要：目的探讨不同复温速度对亚低温治疗新生儿缺氧缺血性脑病(HIE)的影响。方法研究对象为36例亚低温治疗的HIE患儿,随机分为Ⅰ组(n=12,复温速度0.2℃/h)、Ⅱ组(n=12,复温速度0.3℃/h)及Ⅲ组(n=12,复温速度0.4℃/h)。治疗过程中动态监测心率、血压、脉氧饱和度,每日测定血糖、血象、肝肾功能、血钾,并于完成治疗后7、14、28 d根据NBNA评分评定短期疗效,生后3个月及6个月行Bayley婴儿发育量表评估中期疗效。结果(1)复温达标时Ⅲ组血糖明显高于Ⅰ组及Ⅱ组,差异有统计学意义(P<0.05);Ⅲ组复温达标时血糖高于复温前,差异有统计学意义(P<0.05);(2)平均动脉压波动:Ⅲ组平均动脉压波动大于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05);(3)NBNA评分:生后7、14、28 dⅠ组及Ⅱ组NBNA评分明显高于Ⅲ组,差异有统计学意义(P<0.05);(4)生后3月及6月Ⅰ组神经发育指数、心理运动发育指数均高于Ⅱ组及Ⅲ组,差异有统计学意义(P<0.05)。结论亚低温治疗时较慢的复温速度可维持更稳定平均动脉压及血糖水平,有利于改善脑灌注及代谢,起到保护神经功能并改善HIE预后,复温速度过快可能会增加血压波动及高血糖等不良反应的发生。Objective The preliminary analysis about the effect of different rewarming speed on mild hypothermia therapy for HIE.Method Research on 36 cases of mild hypothermia therapy of neonate with HIE,which randomly divided into the GroupⅠ（n=12,rewarming speed 0.2 ℃/h）,the GroupⅡ（n=12,rewarming speed 0.3 ℃/h） and the GroupⅢ（n=12,rewarming speed0.4 ℃/h）.Heart rate,blood pressure and pulse oxygen saturation are dynamically detected during the therapeutic process.Blood glucose,hemogram,hepatorenal function and serum potassium are daily measured.Short-term efficacy is evaluated in accordance with NABA Score when 7,14 and 28 days after treatment.Also the medium-term efficacy is accessed according Bayley Scales of Infant Development at 3-month-old and 6-month-old.Results 1.The blood glucose of the Group Ⅲ is apparently higher than the others when having a good control（P0.05） with statistical significance.2.The mean arterial pressure fluctuation： The Group Ⅲ is apparently higher than the others（P0.05） with statistical significance.3.NABA Score：The NABA Score of the Group Ⅰand the Group Ⅱ of a postnatal baby at 7-day-old,14-day-old and 28-day-old are higher than the Group Ⅲ（P0.05） with statistical significance.4.The MDI and PDI of the Group Ⅰare higher than the others when babies are at 3-month-old and 6-month-old（P0.05） with statistical significance.Conclusion The slowly rewarming speed can maintain the mean arterial pressure and blood glucose level steadily on mild hypothermia therapy,which is in favor of improving brain perfusion and metabolism,especially protecting neurological function and HIE prognosis,while faster rewarming speed may result the blood pressure fluctuation and hyperglycemia.

关 键 词：亚低温 复温速度 新生儿缺氧缺血性脑病(HIE) 新生儿 

分 类 号：R742[医药卫生—神经病学与精神病学]