东莨菪碱治疗新生儿缺氧缺血性脑损伤脑血流及神经行为评分的改变

目的探索东莨菪碱对新生儿缺氧缺血性脑损伤(HIBD)的治疗作用。方法将HIBD病例分成两组,一组接受普通治疗,一组加用东莨菪碱。借助脑单光子发射型计算机断层扫描(SPECT)检测手段,了解东莨菪碱治疗后脑血流改善情况,选择新生儿行为神经评分(NBNA)法判断东莨菪碱的临床疗效。同时将SPECT与CT对HIBD检测的灵敏性进行比较。结果(1)HIBD病变初期轻度HIBDSPECT阳性检出率93%,CT阳性检出率64%,SPECT阳性检出率明显高于CT(P<0.05),中度以上HIBD二者检出率均为100%。(2)东莨菪碱治疗组经10 d治疗后,脑左右侧对称部位放射性摄取比值较普通组明显增高,接近1.0(P<0.05),即东莨菪碱组脑叶血流低灌注较普通组有明显改善。二组治疗前后自身比较脑SPECT检测脑血流灌注均有改善(P<0.01,P<0.05)。(3)新生儿NBNA评分,东莨菪碱组恢复期得分值略高于普通组,但无统计学意义。结论(1)SPECT对轻度HIBD初期检出率明显高于CT,且是动态观察脑血流恢复的敏感指标;(2)东莨菪碱能促进HIBD脑血流低灌注恢复,对HIBD有一定的治疗价值。

The effect of scopolamine on regulation of brain blood flow and behavioral neurological assessment for HIBD in neonates

Objective To evaluate treatment response of scopolamine for hypoxic-ischaemic brain damage(HIBD) in neonates.Methods Neonates with HIBD were assigned into regular therapy group and scopolamine group.SPECT and NBNA scores were used to study improvement of brain blood flow and neurological function respectively.Results (1) The positive detectation rate were 93% and 64% of SPECT and CT in newborns with mild-HIBD at early stage.The difference between them was significant(P<0.05),but there was no difference in neonates with moderate-HIBD.(2) Low flow state of brain lobars was improved explicitly in neonates of scopolamine group than that in neonates of regular therapy group.(3)Neonates of scopolamine group had slight higher NBNA scores and the difference was not significant.Conclusion (1)SPECT was more sensitive than CT For mild-HIBD in neonates at early stage and could dynamically display brain blood flow sensitively.(2)Scopolamine could accelerate recovery of low flow state and was a effective therapy for HIBD in neonates.