选择性头部亚低温治疗新生儿缺氧缺血性脑病效果

目的探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病的效果。方法2004年2月～2007年10月．青岛市妇女儿童医疗保键中心新生儿科收治缺氧缺血性脑病新生儿73例，随机分为亚低温治疗组（亚低温组，32例）和对照组（41例）．亚低温组病儿在生后2～6h内给予选择性头部亚低温治疗，维持肛温在34～35℃，持续72h．对照组在常规对症支持治疗下维持肛温在36．7～37．5℃。通过对两组病儿治疗前及治疗24、48、72、96h时的神经系统表现评分．生后7、28d时的20项新生儿行为神经测定（NBNA）评分及28d时神经系统发育评估评价亚低温治疗新生儿缺氧缺血性脑病的近、远期效果。结果亚低温组治疗24、48、72及96h的神经系统临床表现评分均低于对照组，两组相比差异有显著性（Z=2．321～2．833，P％0．05）。亚低温组28d的NBNA评分明显高于对照组，两组相比差异有显著性（t=5．31．P〈0．05）。亚低温组28d神经系统发育评估高于对照组，两组比较差异有显著性（t=3．57～5．22．P〈0．05）。压低温组伤残率低于对照组，两组比较差异有显著性（y^2=2．55．P〈0．05）。结论选择性头部亚低温治疗对新生儿缺氧缺血性脑病有明显的近期和远期神经保护作用。

SELECTIVE HEAD MILD HYPOTHERMIA FOR NEONATAL HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Objective To assess the effects of selective head mild hypothermia （SHMH） on neonatal hypoxicischemic encephalopathy （HIE）. Methods From Feb. 2004 to Oct. 2007, 73 HIE neonates treated at Qingdao Medical Centre for Women and Children were randomized to treatment group （32 cases） and control group （41 cases）. SHMH was given to treatment group at 2 6 hours after birth for 72 hours, rectal temperature was kept at 34--35 ℃, and the control group was kept the rectal temperature at 36.7--37.5 ℃. The nervous system score before treatment and 24, 48 and 96 hours after therapy,neonatal hehav ioral neurological assessment （NBNA） score at seven and 28 days,and Gesell,S development diagnosis at 28 days were determined to evaluate the effects of SHMH on neonatal HIE. Results Compared with the control, the nervous system scores at 12, 24, 18. and 96 hours after therapy were lower with statistical difference （P〈0. 05）; NBNA scores at seven. 14, and 28 days were higher （P〈0.05）; Gesell,S Development diagnosis at 28 days was higher, rate of disability of nervous system was lower （P〈0.05）. Conclusion Selective head mild hypothermia offers a short and longterm neuroprotective effects on neonates with HIE.