亚低温治疗新生儿缺氧缺血性脑损伤的近期疗效分析

目的 评价亚低温治疗对于围产期窒息后新生儿缺氧缺血性脑损伤的短期疗效.方法 将23例中重度缺氧缺血性脑病(HIE)新生儿分为治疗组(14例)和对照组(9例).治疗组采用选择性头部降温方法,使新生儿直肠温度、鼻咽温度保持34.0～35.0℃、(34.0±0.5)℃,持续72 h;对照组进行常规治疗.动态监测两组患儿血压、心率及神经系统症状.生后28 d采用新生儿神经行为评分(NBNA)进行神经行为发育评价.结果 治疗组随鼻咽温降低,患儿心率减慢,与对照组比较差异有显著性(P＜0.05).在治疗过程中,患儿未发生呼吸暂停、心律失常.治疗组惊厥、拥抱反射、吸吮反射、握持反射及上下肢肌张力等恢复优于对照组.在两组患儿于28 d进行的NBNA测定的结果上,治疗组的测定值为35.00±1.41,明显高于对照组30.67±1.58,差异有显著性(P＜0.05).结论 对于中重度HIE新生儿实行选择性头部降温,维持鼻咽温度于(34.0±0.5)℃,直肠温度维持于34～35℃是安全的,可短期改善神经系统症状,提高近期神经行为评分,但长期疗效仍有待进一步研究.

Short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy

Objective To assess short-time effect of selective head cooling on neonatal hypoxic-ischemic encephalopathy induced by perinatal asphyxia. Methods Twenty-three infants of moderate/severe hypoxic ischemic encephalopathy (HIE) were divided into treatment group ( 14 cases) and control group (9 cases). The head hypothermia in the treatment group [rectal temperature ( 34. 0 ～ 35.0) ℃, nasopharyngeal temperature (34. 0 ± 0. 5 ) ℃]was induced by circulating water cooling cap for up to 72 h. Control group were treated routinely. All newborns were monitored and analyzed for blood pressure, heart rate, neurological function. Neonatal behavioral neurological assessment (NBNA) was conducted for assessment of neurobehavioral development on day 28 after birth. Results Treatment group showed slower hear rate as nasopharyngeal temperature decreased and there was significant difference as compared with the control group ( P ＜ 0.05 ). Apnea and arrhythmia were not found in either group. As compared with the control group, treatment group showed better results in seizure incidence, recovery of neonatal reflex( embracing reflection, sucking reflex and grasp reflex), and improvement of limb muscle tension. The NBNA score on day 28 was much higher in hypothermia group(35.00 ± 1.41 ) than that of control group(30. 67 ± 1.58) and there was significant difference (P ＜ 0.05). Conclusion Selective head cooling is safe for newborns with moderate/severe HIE if the nasopharyngeal temperature maintains at (34 :± 0. 5 ) ℃, rectal temperature at 34 ～ 35 ℃. Selective head cooling can effectively improve the short-term nervous symptoms and the neurobehavioral score,but the long-term efficacy remains to be further studied.