头部亚低温对新生儿缺氧缺血性脑病氧化应激损伤和行为神经评分的影响

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)对氧化应激损伤及新生儿行为神经评分(NBNA)的影响。方法选择2010年1～12月入住本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(观察组)和常规治疗组(对照组),分别检测治疗开始后0h、24h、48h、72h、7天外周血清中超氧化物歧化酶(SOD)和丙二醛(MDA)的浓度,比较两组患儿生后7天、14天及28天的NBNA评分。结果两组患儿治疗开始时SOD浓度和MDA浓度比较差异均无统计学意义(P>0.05)。观察组(28例)在治疗后24h、48h、72h血浆SOD浓度分别为(70.2±10.1)u/ml、(86.8±14.9)u/ml、(108.0±16.9)u/ml,明显高于对照组的(61.5±12.4)u/ml、(65.2±11.0)u/ml、(72.0±13.3)u/ml,血浆MDA浓度分别为(5.23±0.71)mmol/L、(4.40±0.62)mmol/L、(4.28±0.50)mmol/L,明显低于对照组的(6.56±0.70)mmol/L、(7.01±0.67)mmol/L、(6.52±0.66)mmol/L,差异有统计学意义(P均<0.05)。治疗7天两组SOD浓度和MDA浓度比较差异无统计学意义(P>0.05)。生后7天两组患儿NBNA评分比较差异无统计学意义(P>0.05),生后14天、28天观察组NBNA评分明显高于对照组,差异有统计学意义(P<0.05)。结论选择性头部亚低温治疗可通过抑制氧自由基的产生及脂质过氧化物反应,减轻脑缺血再灌注后的氧化应激损伤,起到神经保护作用。

Effects of selective head cooling on oxidative stress and behavioral neurological assessment in neonatal hypoxic-ischemic encephalopathy

Objective To study the changes of superoxide dismutase(SOD)and malondialdehyde(MDA)levels in neonates with hypoxic-ischemic encephalopathy(HIE)treated with selective head cooling with mild hypothermia,also further evaluate the effect of mild hypothermia therapy on oxidative stress injury of HIE and neonatal behavioral neurological assessment(NBNA score). Methods Infants with severe HIE admitted in neonatal intensive care unit between January to December 2010,were randomly assigned to hypothermia treatment group(observation group)and conventional treatment group(control group).Serum levels of SOD and MDA were measured 0 h,24hr,48hr,72hr, 7 d after treatment and compared the NBNA score between two groups after birth 7 d,14 d,28 d.Results There was no statistical difference of SOD and MDA serum levels at the beginning of treatment(P>0.05),the observation group(28 patients)24hr,48hr,72hr post treatment SOD serum levels were (70.2±10.1)u/ml,(86.8±14.9)u/ml,(108.0±16.9)u/ml,were significantly higher than the control group(61.5±12.4)u/ml,(65.2±11.0)u/ml,(72.0±13.3)u/ml,serum levels of MDA were(5.23±0.71)mmol/L,(4.40±0.62)mmol/L,(4.28±0.50)mmol/L,significantly lower than the control group(6.56±0.70)mmol/L,(7.01±0.67)mmol/L,(6.52±0.66)mmol/L,the differences were statistically significant(P<0.05).After birth seven days,the NBNA score between two groups was no statistical significant difference,but was statistically significant higher in observation group 14d,28d after birth(P<0.05).Conclusions Mild hypothermia treatment can inhibit the production of oxygen free radicals and lipid peroxidation reaction,reduce ischemia-reperfusion injury after oxidative stress,and play a neuroprotective role.