亚低温治疗新生儿缺氧缺血性脑损伤临床安全

目的探讨亚低温治疗对中重度新生儿缺氧缺血性脑损伤的安全性。方法将23例中重度缺氧缺血性脑病新生儿随机分为治疗组14例和对照组9例。治疗组采用选择性头部降温方法，使新生儿鼻咽温度保持在（34±0．5）℃，持续72h，对照组进行常规治疗。动态监测血压、心率，检测治疗前后血糖、电解质、肝、肾等功能。结果治疗过程中两组患儿均未发生心率失常、低血糖、低血钾等。治疗组鼻咽温度降低，患儿心率减慢，与对照组比较差异有统计学意义（P〈0．05）。治疗72h后，两组pH，Na＋、K＋、Ca2＋浓度，血肌酐、尿素氮、肌酸激酶比较，差异均无统计学意义。结论对于中重度新生儿缺氧缺血性脑病实行选择性头部降温，维持鼻咽温度于（34±0．5）℃，直肠温度于34±35℃是安全的，可应用于具有重症监护条件的新生儿病房。

Research on safety of mild hypothermia on treating neonatal encephalopathy

Objective To assess the potential side effects and efficacy of mild hypothermia to neonatal moderate/severe encephalopathy. Methods Twenty three infants of moderate/severe hypoxic ischemic encephalopathy （HIE） were randomly divided into the treatment group （n=14） and the control group （n=9）. The nasopharyngeal temperature of the head hypothermia in the treatment group, rectal temperature 34.0-35.0 ℃ was kept at （34.0±0.5）℃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, blood glucose, electrolytes, hepatic and kidney function. Results Breath holding, arrhythmia, hypoglycemia, hypopotassaemia were not found in either group. Treatment group showed slower heart rate as nasopharyngeal temperature decreased and there was significant difference compared with the control group （P 〈0.05）. pH, Na＋, K＋, Ca2＋, serum creatinine, blood urea nitrogen and creatine kinase showed no difference after 72 h. 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 ℃.Therefore it can be used in regular neonate ICU setting.