选择性头部亚低温治疗新生儿缺氧缺血性脑损伤的观察及护理

目的研究新生儿缺氧缺血性脑损伤（hypoxie—ischemic brain damage，HIBD）选择性头部亚低温治疗的临床疗效和护理。方法将2002年1月至2005年12月我院NICU收治的78例重度窒息足月新生儿随机分成观察组（46例）与对照组（32例），两组均进行抗掠厥、防治脑水肿、维持正常脑代谢、静脉营养等治疗，观察组在常规治疗基础上加用选择性头部降温，治疗期间持续监测心率、呼吸、血压、经皮氧饱和度、直肠温度等，动态检测血糖、血气分析、电解质、出凝血时间等，并在治疗前后进行脑电图（EEG）检查和新生儿神经行为评分（neonatal behavioral neurological assessment，NBNA），作为疗效观察指标。结果两组患儿治疗后EEG、新生儿神经行为评分（NB—NA）均有显著性差异（P〈0．05），两组患儿治疗后24h、48h、72h心率比较有显著性差异（P〈0．05），而呼吸、收缩压、舒张压、血糖、钠离子浓度、钾离子浓度等无显著性差异（P〉0．05）。结论选择性头部亚低温在新生儿HIBD治疗中是有效、安全、可行的。

Selective Head Sub-hypothermia in Treatment of Newborns with Hypoxic-Ischemic Brain Damage:Clinical Outcome and Nursing

Objective To study the effectiveness of selective head sub-hypothermia in treatment of newborns with Hypoxic-Ischemic Brain Damage(HIBD).Methods Seventy-eight patients with HIBD(Jan 2002 to Dec.2005) were randomly divided into treatment group(n=46) and control group(n=32).All patients were treated according to routing HIBD therapeutic scheme;the treatment group was also given selective head sub-hypothermia.The heart rates,breath rates,BP,rectal temperature,percutaneous blood oxygen saturation(SaO2),blood sugar,blood gas analysis and biochemical tests were measured during treatment.EEG and neonatal behavioral neurological assessment(NBNA) were also conducted.Results There were significant differences in EEG and NBNA tests between the 2 groups(P<0.05).The heart rate of treatment group reduced significantly compared with that of the control group(P<0.05).There were no significant differences in breath,BP,SaO2,blood sugar and biochemical between the 2 groups.Conclusion Sub-hypothermia is a safe,effective and easy to perform method for treatment of HIBD newborns.