选择性头部亚低温治疗新生儿缺氧缺血性脑病对血清NSE及NBNA评分影响

目的探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病（HIE）对血清神经元特异性烯醇化酶（NSE）及新生儿行为神经评分（NBNA）的影响。方法选择2012年12月入住濮阳市人民医院新生儿重症监护病房的中、重度HIE患儿，随机分为亚低温治疗组和常规治疗组，分别监测治疗开始后0、24、48、72h外周血清NSE含量；比较两组患儿生后7、14、28d新生儿NBNA评分。结果在治疗后观察组0、24、48、72hNSE水平分别为（20．32±6．75）ng／L、（23．26±2．89）ng／L、（38．12±7．96）ng／L、（31．91±10．14）ng／L；对照组分别为（19．76±3．82）ng／L、（24．41±5．91）ng／L、（48．67±9．96）ng／L、（41．78±3．46）ng／L；两组血清NSE含量在0、24h比较差异无统计学意义（P〉0．05），在48、72h亚低温治疗组NSE明显低于常规治疗组，差异有统计学意义（P〈0.05）。生后7d，两组患儿NBNA评分比较，差异无统计学意义（P〉0．05），生后14、28d NBNA评分比较，亚低温治疗组明显高于常规治疗组，差异有统计学意义（P〈0．05）。结论选择性头部亚低温治疗能有效降低NSE水平，具有脑保护作用，对改善患儿预后有积极作用。

Effects of selective head cooling with mild hypothermia on neuron-specific enolase in serum and behavioral neurological assessment in neonatal hypoxic-ischemic encephalopathy

Objective ] To study the changes of neuron-specific enolase （NSE） of serum levels in neonates hypoxic- ischemic encephalopathy（HIE） treated with selective head cooling with mild hypothermia,also evaluate the effect of mild hypothermia therapy on neonatal behavioral neurological assessment （NBNA score） . Methods ] Infants with severe HIE admitted in neonatal intensive care unit between January to December 2012, were randomly assigned to hypothermia treatment group （abservation group） and conventional treatment group（control group）. Serum levels of NSE were measured 0,24,48,72 h, 7 d after treatment and compared the NBNA score between two groups after birth 7, 14, 28 d. Results ] The abservation group 0,24,48,72 h post treatment NSE serum levels were （20.32±6.75） ng/L,（23.26 ±2.89） ng/L,（38.12± 7.96） ng/L,（31. 91 ± 10.14） ng/L; The control were （19.76 ±3.82） ng/L,（24.41 ± 5.91） ng/L,（48.67 ± 9.96） ng/L,（41.78± 3.46） ng/L.There was no statistical diffrence of NSE serum levels at 0hr, 24hr post treatment （P〉0.05）, But the abservation group 48, 72 h post treatment NSE serum levels significantly lower than the control group, the diffrenees were statistical diffrenee （P〈0.05）. After birth seven days, the NBNA score between two groups was no statistical significant diffrence, but was statistically significant higher in abservation group 14d, 28d after birth （P〈0.05）. Conclusion ] The treatment of selective head cooling with mild hypothermia can effectively decrease the level of NSE, can play a neuroprotective role, it plays an active role in improving the prognosis of children.