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目的分析脉络宁、大剂量地塞米松、高压氧(HBO)联合治疗及常规治疗新生儿缺氧缺血性脑病(hypoxia isdischemic encephalopathy,HIE)的临床疗效。方法联合治疗组47例,给予HBO、脉络宁及大剂量地塞米松联合治疗;对照组46例,给予常压下吸氧及胞二磷胆碱、脑活素营养脑细胞对症治疗等。联合治疗组脉络宁0.5ml/(kg·d)加入10%葡萄糖50ml静脉滴注,每日1次,10d为1疗程;生后24h地塞米松2mg/(kg·d),每日分2次静脉滴注,连用3d后停药;HBO应用透明婴儿单人氧舱,加压减压时间分别为15和20min,绝对压力为0.05～0.06MPa,氧浓度为65%～90%,每次1h,每日1次,10次为1疗程(一般为一二个疗程)。结果联合治疗组疗效为显效26例(55.3%),有效16例(34.0%),无效5例(10.7%),其中死亡3例(6.4%),总有效率为89.3%。对照组疗效为显效14例(30.4%),有效17例(37.0%),无效15例(32.6%),其中死亡14例(30.4%),总有效率为67.4%。两组比较χ2=6.65,P<0.01;病死率比较,χ2=9.02,P<0.01,差异均有统计学意义。两组患儿反应、颅压、肌张力、特有神经反射及其他临床症状恢复时间,治疗组平均为(4.3±1.1)d,对照组为(6.7±1.2)d,治疗组较对照组平均缩短2.4d,两组比较,差异有统计学意义(t=10.2,P<0.01)。结论应用脉络宁、大剂量地塞米松及HBO联合治疗HIE组疗效优于常规治疗组。
Objective To investigate the curative effect of Mailuoning, high-dose dexamethasone and hyperbaric oxygen (HBO) combined with routine treatment of hypoxia isdischemic encephalopathy (HIE). Methods Forty-seven patients in combination therapy were given HBO, Mailuoning and high-dose dexamethasone. In control group, 46 patients were given oxygen and citicoline under normal pressure, symptomatic treatment of cerebrolysin brain cells. The combination therapy group Mailuoning 0.5ml / (kg · d) by adding 10% glucose 50ml intravenous drip once a day, 10d for a course of treatment; dexamethasone 2mg / (kg · d) Intravenous drip, once a day after discontinuation; HBO application of transparent baby single oxygen chamber, pressure decompression time were 15 and 20min, the absolute pressure of 0.05 ~ 0.06MPa, oxygen concentration of 65% to 90%, each time 1h, 1 day, 10 times for a course of treatment (usually one or two courses). Results The curative effect of combined treatment group was markedly effective in 26 cases (55.3%), effective in 16 cases (34.0%), ineffective in 5 cases (10.7%), and death in 3 cases (6.4%). The total effective rate was 89.3%. Control group was markedly effective in 14 cases (30.4%), effective in 17 cases (37.0%), ineffective in 15 cases (32.6%), of which 14 died (30.4%), the total effective rate was 67.4%. Two groups compared χ2 = 6.65, P <0.01; mortality, χ2 = 9.02, P <0.01, the differences were statistically significant. The response time, intracranial pressure, muscle tension, specific nerve reflex and other clinical symptoms recovery time in the two groups were (4.3 ± 1.1) days in the treatment group and 6.7 ± 1.2 days in the control group, and were shorter in the treatment group than in the control group 2.4d, the difference between the two groups was statistically significant (t = 10.2, P <0.01). Conclusion Mailuoning, high-dose dexamethasone and HBO combined treatment of HIE group is better than the conventional treatment group.