单唾液酸四己糖神经节苷脂对重度窒息新生儿脑损伤程度的影响

目的:探讨单唾液酸四己糖神经节苷脂(GM1)对重度窒息新生儿脑损伤程度的影响。方法:78例重度窒息复苏后的新生儿随机分为两组:常规治疗组(对照组)39例,即在对症支持处理的基础上使用脑活素和胞二磷胆碱治疗;GM1治疗组39例,在常规治疗的基础上尽早(生后6h内)应用GM1治疗。观察与比较两组惊厥的发生和病死率,缺氧缺血性脑病(HIE)的临床、CT分度和行为神经评分测定。结果:GM1治疗组惊厥的发生率明显低于对照组(30.77%vs56.41%,χ2=4.2233,P<0.05);前者重度HIE(包括头颅CT脑白质低密度呈中、重度改变者)的发生率亦明显低于后者(P<0.05);生后7～8d和12～14d的行为神经评分<35分者所占百分比GM1治疗组明显低于对照组(45.95%vs75.86%,χ2=4.8451,P<0.05;29.73%vs58.62%,χ2=4.4357,P<0.05);GM1治疗组的病死率亦显著低于对照组(5.13%vs25.64%,χ2=4.8258,P<0.05)。结论:对重度窒息的新生儿,在对症支持治疗基础上尽早使用GM1能显著减轻缺氧缺血性脑损伤程度,并降低其病死率。

Effects of monosialotetrahexosylganglioside on brain damage following severe asphyxia in neonates

Objective:To investigate the effects of monosialotetrahexosylganglioside (GM1) on brain damage following severe asphyxia in neonates.Methods:Seventy-eight cases of perinatal severe asphyxia were randomly assigned to two groups: the control group (39 cases) received routine treatment(including cerebrolysin and citicoline); the study group (39 cases) was given GM1 on the basis of routine treatment as early as possible (within six hours after birth). The incidence of convulsion and the mortality were observed; the degree of hypoxic-ischemic encephalopathy (HIE) was evaluated; and the Neonatal Behavioral Neurological Assessment (NBNA) was done in both groups.Results:There was significantly lower incidence of convulsion, in the asphyxiated newborns treated by GM1, as compared to that of the control group(30.77% vs 56.41%, χ2=4.223 3,P<0.05).The incidence of serve HIE was also significantly lower in the study group than that in the control group (P<0.05). The percentage of the cases whose NBNA marks were less than 35 at 7~ 8 d and 12 ~ 14 d after birth in the study group was much lower than that in the control group(45.95% vs 75.86%, χ2=4.845 1, P<0.05;29.73% vs 58.62%,χ2=4.435 7, P<0.05). The mortality of the study group was also lower (5.13% vs 25.64%, χ2=4.825 8, P<0.05 ).Conclusion:Using GM1 on the basis of the routine treatment as early as possible after resuscitation can reduce markedly the severity of asphyxia-induced brain damage in neonates.