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目的研究选择性头部亚低温对HIE新生儿微循环的影响。方法 HIE患儿52例分为常规治疗组(常温组26例,其中轻度13例、中度9例、重度4例)和常规治疗加选择性头部亚低温治疗组(亚低温组26例,其中轻度12例、中度9例、重度5例),常温组维持体温在36.0～37.5℃,亚低温组维持鼻咽温度在(34.0±0.5)℃,分别在治疗前,治疗24 h、48 h、72 h和120 h,采用耳廓微循环检测技术对其进行微循环动态监测(红细胞聚集率、白色微小血栓出现率、细静脉流速和微血管畸形率)。30例健康新生儿作为健康对照组。结果 HIE患儿红细胞聚集率、白色微小血栓出现率、细静脉流速、微血管畸形率均有显著改变,尤其是在24 h内最为明显,与健康对照组比较各项指标均有统计学差异(Pa<0.05)。而且随着疾病严重程度的增加,这种微循环变化也会越显著。与常温组比较,亚低温组患儿的红细胞聚集率、白色微小血栓出现率在恢复期下降得更快,细静脉流速恢复更快,且差异均有统计学意义(Pa<0.05);而微血管畸形率无统计学差异(P>0.05)。结论 HIE新生儿微循环发生障碍,且这种变化与HIE严重程度成正比;选择性头部亚低温治疗新生儿HIE有利于改善微循环。
Objective To study the effects of selective head hypothermia on microcirculation in neonatal HIE. Methods 52 children with HIE were divided into routine treatment group (26 in normal temperature group, 13 in mild group, 9 in moderate grade and 4 in severe group) and routine treatment plus selective head hypothermia treatment group (26 in hypothermia group , Mild in 12, moderate in 9 and severe in 5). The body temperature in the normal temperature group was 36.0-37.5 ℃, and the nasopharyngeal temperature in the mild hypothermia group was (34.0 ± 0.5) ℃, respectively, before treatment and 24 h , 48 h, 72 h and 120 h. Microcirculation dynamic monitoring (erythrocyte aggregation rate, white micro thrombus incidence rate, venular flow rate and microvascular malformation rate) was performed using auricle microcirculation detection technique. 30 healthy newborns as healthy control group. Results The rate of erythrocyte aggregation, the incidence of white tiny thrombus, the flow rate of fine vein and the rate of microvascular malformations in HIE children were all significantly changed, especially in 24 h, which were significantly different from those in healthy controls (Pa <0.05). And as the severity of the disease increases, this microcirculation changes more dramatically. Compared with the normal temperature group, the rate of erythrocyte aggregation and the incidence of white microthrombosis in the mild hypothermia group decreased more rapidly in the convalescent period, and the velocity of the venous vein recovered faster, with statistical significance (Pa <0.05); while the microvessel There was no significant difference in deformity rate (P> 0.05). Conclusions The microcirculation of neonates with HIE is impaired, and this change is directly proportional to the severity of HIE. Selective head hypothermia in neonates with HIE is helpful to improve microcirculation.