选择性头部亚低温治疗在新生儿缺氧缺血性脑病中的应用

目的观察选择性头部亚低温治疗在新生儿缺氧缺血性脑病（HIE）中的作用及寻找亚低温治疗的最佳时间窗。方法选取120例符合HIE诊断患儿，随机分为亚低温组和对照组各60例，观察近期疗效和远期疗效。再将亚低温组分为6个小组，每组各10例，比较治疗前和治疗72h后神经元特异性烯醇化酶（NSE）的情况。结果亚低温组在生后7、14、28d的新生儿行为神经评分（NBNA评分）比较明显高于对照组（P〈0．05）；亚低温组在生后6、12个月的智力发育指数（MDI）和精神运动发育指数（PDI）均高于对照组（P〈0．05）。亚低温组内6个小组的治疗前和亚低温治疗72h后，NSE均明显下降（P〈0．05），其中第1—4小组治疗前后NSE比较差异较大。结论使用选择性头部亚低温治疗HIE对患儿的近期和远期治疗有明显效果，且在不同时间开始治疗具有差异性．研究表明及早开始行亚低温治疗HIE对预防神经损害效果更佳。

The application of elective cephalic hypothermia for treatment of newborn hypoxic-ischhemic encephalopathy

[ Objective ] To observe the effect and search the optimal time of elective cephalic mild hypothermia for treatment of new born hypoxic-ischemic encephalopathy. [ Methods ] 120 cases were divided into mild hypothermia group and the control group and 60cases in each group randomly, observing the recent efficacy and prostecdtive efficacy. Then the hypothermia group was divided into six groups, each group of 10 cases, compared the information of NSE before treatment and post-treatment after 72 h. [ Results ] After 7 d ,14 d and 28 d birth, the NBNA score of hypothermia group was significantly higher than the control group, P〈0.05; After 6 and 12 months born, the mental development index （MDI） and psychomotor development index （PDI） of hypothermia group were higher than the control group, P〈0.05.6 groups of hypothermia group before the treatment and the mild hypothermia for treatment after 72 hours, NSE were significantly decreased, P〈0.05, NSE difference of 1-4 groups is comparatively larger before and after the treatment. [ Conclusion ] To use elective cephalic mild hypothermia for treatment of new born hypoxic-ischemic eneephalopathy in the recent efficacy and prostecdtive efficacy has obvious effect, and there are differences in different time to start treatment, Starting mild hypothermia for treatment of HIE early could conduce to prevent nerve damage effect is better.