亚低温治疗前温度控制对新生儿缺氧缺血性脑病预后的影响

目的 分析亚低温使用过程中部分环节对新生儿缺氧缺血性脑病(HIE)短期预后的影响,为HIE的临床治疗提供科学依据。方法 选择2016年8月3日—2018年12月31日成都市妇女儿童中心医院的90例中重度HIE患儿亚低温治疗的相关资料进行回顾性分析,其中中度HIE患儿73例,重度HIE患儿17例。按照不同时间窗(6 h vs.12 h)分组,在6 h组再按照窒息复苏后是否进行复温分为升温组及降温组两组,收集亚低温治疗前后的振幅整合脑电图(aEEG)数据、住院时间、一般临床特征。结果 重度HIE患儿窒息复苏后6～12 h开始亚低温治疗,不同时间窗治疗后aEEG图形评分差异有统计学意义(5.54±2.06 vs.3.00±1.41,t=2.27,P＜0.05)。窒息复苏后尽快进行主动降温组与进行保暖复温组比较,亚低温治疗结束后24 h主动降温组的aEEG图形评分更高,且重度患儿两组间差异有统计学意义(4.63±2.06 vs.7.00±1.00,t=-2.37,P＜0.05)。结论 窒息复苏后尽早进行亚低温治疗可升高治疗后aEEG图形分值,改善神经系统表现,一定程度上改良短期预后,长期预后需进一步随访。

Effect of temperature control before mild hypothermia treatment on prognosis of neonatal hypoxic-ischemic encephalopathy

Objective To explore the influence of some links in clinical mild hypothermia on the short-term prognosis of neonatal hypoxic-ischemic encephalopathy (HIE),in order to provide scientific basis for the clinical treatment of HIE. Methods Data of mild hypothermia treatment of 90 children with moderate and severe HIE admitted in Chengdu Women's and Children's Central Hospital from August 3rd,2016 to December 31st,2018 were collected and analyzed retrospectively.There were 73 children with moderate HIE and 17 children with severe HIE.All cases were divided into two groups according to different time windows (6 h vs.12 h),and the 6 h group was divided into two groups according to whether being rewarmed or not.Amplitude integrated electroencephalogram (aEEG) data,hospitalization time and general clinical characteristics were collected before and after mild hypothermia treatment. Results Mild hypothermia therapy was started 6 hours and 6-12 hours after resuscitation of asphyxia,and there was significant difference on aEEG graph score between different time windows(5.54±2.06 vs.3.00±1.41,t=2.27,P＜0.05).The aEEG graph score of the active cooling group was higher 24 hours after the end of mild hypothermia treatment than that of the warm-keeping rewarming group (4.63±2.06 vs.7.00±1.00,t=-2.37,P＜0.05). Conclusion s Mild hypothermia therapy as soon as possible after resuscitation of asphyxia can increase aEEG waveform score after treatment and improve short-term prognosis to some extent.Further follow-up is warranted for long-term prognosis.