头部亚低温不同治疗时间窗对新生儿中重度缺氧缺血性脑病疗效观察

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）不同治疗时间窗对神经系统的保护作用。方法：选择2008年1月至2012年10月我院新生儿科收治的中、重度HIE患儿,随机分为生后3 h内进行选择性头部亚低温治疗组、生后3~6 h治疗组、生后6 h以上治疗组及对照组。对各组患儿生后28 d行新生儿20项行为神经测定（NBNA）评分,同时监测严重伤残例数及死亡例数。结果：共117例患儿完成了治疗和随访,其中亚低温治疗生后〈3 h组30例,3~6 h组29例,〉6 h组29例,对照组29例。四组NBNA评分分别为（38.5±5.5）分、（37.6±5.5）分、（30.1±4.9）分、（31.2±4.4）分,〈3 h组和3~6h组患儿生后28 d NBNA评分均高于〉6 h组和对照组（P〈0.05）,而〈3 h组和3~6 h组之间以及〉6 h组和对照组之间的NBNA评分比较差异无统计学意义（P〉0.05）;〈3 h组和3~6 h组患儿严重伤残率（3.33%＆3.44%）和病死率（0%＆0%）均低于〉6 h组和对照组（17.2%＆13.8%,10.3%＆10.3%）（P〈0.05）,而〈3 h组和3~6 h组之间以及〉6 h组和对照组之间严重伤残率和病死率比较差异无统计学意义（P〉0.05）。结论：生后〈6 h开始的选择性头部亚低温治疗对新生儿神经系统近期和远期功能恢复都有明显疗效,明显优于生后6 h开始的治疗,〉6 h则明显无效,而进一步提前开始治疗的时间并无更好的临床疗效。

Efficacy of Different Window Time of Head Mild Hypothermia on the Prognosis of Moderate/Severe Neonatal Hypoxic-Ischemic Encephalopathy

Objective： To explore the efficacy of different window time of head mild hypothermia on the prognosis of moderate/severe neonatal hypoxie-ischemie eneephalopathy. Methods： From January 2008 to October 2012, based on selective head mild hypothermia therapy with different treatment window time, newborns with moderate/severe hypoxic-ischemie encephalopathy （ HIE ） were randomly divided into four groups： a 〈 3 h group, a 3 - 6 h group, a 〉 6 h group and a control group. The twenty behavioral neurological assessments of the newborns （NBNA） on 28 days after birth and the numbers of severely disable were monitored. Results： The scales of NANB of neonates in 〈3 h group and 3 -6 h group were significantly higher, the scores of 〈3 h, 3 -6 h,〉6 h and the control groups were （38.5±5.5）, （37.6±5.5）, （30. 1±4.9） and （31.2±4.4）, respectively, and the occurrence of severely disable （the occurrences of 〈3 h, 3 -6 h, 〉6 h and the control groups were 3.33% , 3.44% , 17.2% and 13.8% , respectively） and death cases （the occurrences of death case of 〈3 h, 3 -6 h, 〉6 h and the control groups were 0% , 0% , 10.3% and 10.3% , respectively） were lower than those of children in 〉6 h and the control group. But no markedly difference was found between 〈3 h group and 3 -6 h group, 〉6 h and the control group, respectively （P〉0.05）. Conclusions： The treatment window time of selective head mild hypothermia therapy for 〈6 h on neonatal HIE showed short-term and long-term functional recovery on nervous system. The advance of treatment window time less than 3 hours has no more treatment effect on HIE.