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目的 研究新生儿缺氧缺血脑损伤的亚低温临床实施方法。方法 对1999年7月～2000年3月,上海医科大学附属儿科医院新生儿监护病房收治出生体重为(3.42±0.56)kg,Apgar评分5min<5,生后6h内存在脑电图异常和/或临床神经系统症状和体征的11例足月重度窒息新生儿,选择性头部降温,维持鼻咽温度为(34±0.2)℃,持续72h,动态24h心肺功能及呼吸暂停、血气分析、血糖、血电解质等监测。结果 选择性头部降温将鼻咽温度下降至34℃所需时间为(45±25)min。亚低温治疗后复温至35.5℃所需时间为(450±175)min。降温初期鼻咽-直肠温差为1.5℃,降温至72h鼻咽-直肠温差为0.5℃。亚低温实施过程中,无硬肿、呼吸暂停、心律失常、抽搐、低血压、DIC等发生。治疗24、28、72h患儿心率低于治疗前,差异有显著性,治疗24、48h血钙水平低于治疗前,差异有显著性,呼吸、收缩压、舒张压、平均压、血糖、Na~+、K~+与治疗前比较差异无显著性,但治疗中存在代谢性酸中毒。结论 选择性头部降温方法在新生儿亚低温治疗中是可行的。
Objective To study the clinical practice of hypothermia in neonatal hypoxic-ischemic brain damage. Methods From July 1999 to March 2000, the neonatal intensive care unit of Shanghai Medical University Pediatric Hospital admitted birth weight (3.42 ± 0.56) kg, Apgar score 5min <5, 6 hours after birth, there are EEG abnormalities and / 11 neonates with severe full-term asphyxia of clinical nervous system symptoms and signs were treated with selective head cooling to maintain the nasopharyngeal temperature at (34 ± 0.2) ℃ for 72 h, dynamic 24h cardiopulmonary function and apnea, blood gas analysis, blood glucose , Blood electrolytes and other monitoring. Results Selective head cooling reduced the nasopharyngeal temperature to 34 ° C (45 ± 25) min. The time required for rewarming to 35.5 ° C after mild hypothermia was (450 ± 175) min. The initial temperature of nasopharynx - rectal temperature was 1.5 ℃, cooling to 72h nasopharyngeal - rectal temperature was 0.5 ℃. Mild hypothermia in the implementation process, no hard swelling, apnea, arrhythmia, convulsions, hypotension, DIC and so on. The heart rate of children in 24, 28 and 72 hours after treatment was lower than that before treatment, and the levels of serum calcium in 24 and 48 hours after treatment were lower than those before treatment. Respiratory, systolic blood pressure, diastolic blood pressure, mean pressure, blood glucose, Na ~ +, K ~ + no significant difference compared with before treatment, but the treatment of metabolic acidosis. Conclusion The selective head cooling method is feasible in the treatment of neonatal hypothermia.