不同时间窗全身亚低温治疗新生儿缺氧缺血性脑病的临床探讨  

Clinical study of hypothermic ischemic encephalopathy in neonates treated with different time windows

作　　者：张文明[1] 李炎[1] 黎炽旺 

机构地区：[1]广东省梅州市人民医院新生儿科,广东梅州514031

出　　处：《中国医药科学》2016年第22期48-50,共3页China Medicine And Pharmacy

摘　　要：目的探讨不同时间窗全身亚低温治疗中重度新生儿缺氧缺血性脑病（HIE）的临床疗效。方法选取我院新生儿科2013年6月~2016年7月确诊中重度HIE患儿46例,按入院时出生时间分为治疗组24例及对照组22例,治疗组为生后6h内行亚低温治疗,对照组为生后6h后行亚低温治疗。两组患儿在出生体重、胎龄、Apgar评分方面比较差异无统计学意义。两组患儿在入院后即行全身亚低温治疗及其他对症支持治疗措施,均行直肠温度持续监测,维持目标温度33.5~34℃,同时监测血压、心率、经皮血氧饱和度,定期检测血气分析、血糖、肝肾功能、凝血五项、电解质及血常规,持续72h后复温;生后7d行24h动态脑电图检查,生后14、30d以新生儿神经行为测定（NBNA）进行神经行为发育评价。结果两组患儿治疗后均未出现严重循环功能不全、心律失常、凝血异常等并发症,两组患儿在入院时均有代谢性酸中毒及部分患儿有肝肾功能损害,治疗后均已纠正,均无死亡病例;但治疗组患儿生后7d动态脑电图显示最高电压及最低电压均较对照组高,差异有统计学意义（P〈0.05）;生后14、30d NBNA评分明显高于对照组,差异有统计学意义（P〈0.05）。结论生后6h内行亚低温治疗中重度新生儿缺氧缺血性脑病能明显减轻急性期症状,减少神经系统后遗症,提高生存质量。Objective To investigate the clinical effect of different time windows in the treatment of moderate and severe neonatal hypoxic ischemic encephalopathy（HIE）.Methods 46 cases of severe HIE cured in our hospital from June 2013 to July 2016 were selected as the study objects.According to the admission time,they were divided into treatment group of 24 cases and control group of 22 cases.Patients in treatment group were born within 6 hours after mild hypothermia treatment,and patients in control group were 6 hours after mild hypothermia treatment after birth.There was no significant difference in birth weight,gestational age and Apgar score between the two groups.Two groups of children were in hospital after mild hypothermia treatment and other symptomatic treatment measures,underwent continuous monitoring of rectal temperature,maintaining the target temperature 33.5-34 ℃,and monitoring of blood pressure,heart rate,percutaneous oxygen saturation,blood glucose,blood gas analysis,regular detection of liver and kidney function,blood coagulation five,electrolyte and blood,72 hours after rewarming.7 days later 24 hour ambulatory EEG examination,after 14 days and 30 days in the neonatal behavioral neurological assessment（NBNA） to evaluate the development of nervous behavior.Results The two groups after treatment in children with no serious circulatory insuf ficiency,arrhythmia,coagulation disorders and other complications,two groups of children were on admission metabolic acidosis and some patients had liver and kidney function damage after treatment have been corrected,there were no deaths.But the treatment group in 7 days after birth of AEEG show the highest voltage and the minimum voltage was higher than the control group,（P〈0.05）,and there were significant differences.14 days after birth,30 days NBNA score significantly higher than the control group（P〈0.05）,and there was significant difference.Conclusion Within 6 hours after birth,mild hypothermia therapy can significantly reduce the acute phase sy

关 键 词：时间窗 亚低温 新生儿缺氧缺血性脑病 

分 类 号：R742[医药卫生—神经病学与精神病学]