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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)不同持续时间对神经系统保护的影响。方法选择2006年4月至2010年10月佛山市南海区黄岐医院新生儿科收治的中重度HIE患儿,随机分为选择性头部亚低温治疗48h组、72h组、96h组及对照组。对各组患儿生后28天行新生儿20项行为神经测定(NBNA)评分、18月龄时采用贝利婴儿发育量表进行神经行为发育评价,同时监测治疗不良反应、严重伤残例数及死亡例数。结果共105例患儿完成了治疗和随访,亚低温治疗48h组、72h组、96h组及对照组完成治疗的例数分别为27、26、26及26例。72h组和96h组患儿生后28天NBNA评分和18月龄时贝利评分均显著高于48h组和对照组[NBNA评分:(38.2±5.5)、(37.6±5.7)比(32.5±3.7)、(31.1±3.8),神经发育指数:(98.4±12.5)、(100.1±13.7)比(88.7±13.3)、(85.1±10.9),心理运动发育指数:(101.7±15.8)、(99.6±14.1)比(89.2±11.9)、(87.0±13.3),P<0.05],严重伤残发生率和病死率均低于48h组和对照组[严重伤残:7.7%、11.5%比22.2%、23.0%,病死率:0、0比11.1%、7.7%,P<0.05];而72h组和96h组之间、48h组和对照组之间差异无统计学意义(P>0.05)。96h组血小板减少、电解质紊乱及血糖异常的发生率高于48h组和72h组(P<0.05),48h组和72h组之间差异无统计学意义(P>0.05)。结论选择性头部亚低温治疗持续72h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48h;而延长低温持续时间可能会增加不良反应的发生。
Objective To investigate the effects of selective head mild hypothermia on nervous system protection in neonates with hypoxic-ischemic encephalopathy (HIE) for different durations. Methods From April 2006 to October 2010, patients with moderate-severe HIE admitted to Department of Neonatology, Huangqi Hospital, Nanhai District, Foshan City were randomly divided into 48h, 72h, 96h group and control group. Twenty newborns’ Behavioral Nerve Testing (NBNA) scores were performed on the 28th day after birth in each group, and neurobehavioral development was evaluated at 18 months of age using the Bell Pacific Infant Development Scale. At the same time, adverse reactions, And the number of deaths. Results A total of 105 children were treated and followed up. The number of cases treated with mild hypothermia for 48h, 72h, 96h and control groups were 27, 26, 26 and 26, respectively. The NBNA score at 28 days and the Bailey score at 18 months were significantly higher in 72h group and 96h group than those in 48h group and control group [NBNA score: (38.2 ± 5.5), (37.6 ± 5.7) vs (32.5 ± 3.7) ), (31.1 ± 3.8), (98.4 ± 12.5), (100.1 ± 13.7), (88.7 ± 13.3) and (85.1 ± 10.9) respectively. The indexes of psychomotor development were (101.7 ± 15.8) and (99.6 ± 14.1) were significantly lower than those in 48h group and control group [(89.2 ± 11.9) vs (87.0 ± 13.3), P <0.05] 23.0%, and the case fatality rate was 0, 0, 11.1%, 7.7%, P <0.05). There was no significant difference between the 72h group and the 96h group and between the 48h group and the control group (P> 0.05). The incidence of thrombocytopenia, electrolyte imbalance and abnormal blood glucose in 96h group was higher than those in 48h and 72h group (P <0.05). There was no significant difference between 48h and 72h group (P> 0.05). Conclusion Selective head mild hypothermia treatment for 72h has obvious curative effect on the recovery of nervous system in short-term and long-term, which is obviously better than 48h; prolonging the duration of low temperature may increase the incidence of adverse reactions.