亚低温联合神经节苷脂治疗新生儿缺氧缺血性脑病的疗效分析

Effect of cephalic sub-hypothermia therapy combined with ganglioside on neonates with hypoxic-ischemic encephalopathy

目的探讨头部亚低温联合神经节苷脂治疗新生儿缺氧缺血性脑病(hypoxic ischemic encephalopathy,HIE)不同时期的效果。方法选取我院NICU 2012年1月-2013年5月收治的74例HIE新生儿,随机分为治疗组(38例)与对照组(36例),对照组采用头部亚低温治疗,治疗组在对照组治疗基础上联合使用神经节苷脂治疗。比较两组出生7 d时血清神经元特异性烯醇化酶(neuron specific enolase,NSE)的水平,出生7 d及28 d的神经行为测定(neonatal behavioral neurological assessment,NBNA)评分,18月龄的Bayley婴儿发育量表评分,出生6年时WPPSI-Ⅲ量表评分,同时比较两组存活率。结果经过治疗,出生7 d时治疗组与对照组NBNA评分(31.42±3.75 vs 31.81±4.02)及血清NSE水平(12.94±2.87 vs 13.27±3.05)差异均无统计学意义(P均>0.05);但治疗组生后28 d的NBNA评分(35.03±2.12)高于对照组(33.61±2.61)(P=0.012)。治疗组出生后18个月智力发育指数(91.11±15.09 vs 82.69±12.95)、心理运动发育指数(90.39±13.00 vs 81.78±14.70)均高于对照组(P均<0.05)。治疗组出生6年时的IQ值高于对照组(83.58±18.92 vs 72.93±15.65,P=0.024)。治疗组中IQ 70分以下例数低于对照组(11例vs 17例),IQ 85分以上患儿例数高于对照组(18例 vs 8例)(P均<0.05)。治疗组和对照组出生后18个月存活率(94.74% vs 88.88%)及6年存活率(81.58% vs 75.00%)均无统计学差异(P>0.05)。结论亚低温联合神经节苷脂治疗新生儿HIE能提高患儿短期、中期神经行为及远期的精神发育程度,具有很好的应用前景。

Objective To investigate the effects of cephalic sub-hypothermia therapy combined with ganglioside injection in treatment of neonatal hypoxic ischemic encephalopathy (HIE).Methods A total of 74 cases with HIE treated in our hospital from January 2012 to May 2013 were randomly divided into treatment group (n=38) and control group (n=36).The neonates in the control group were treated by cephalic sub-hypothermia,while the neonates in the observation group were treated by sub-hypothermia combined with ganglioside.The serum neuron specific enolase (NSE) level at 7 d after birth,and neonatal behavioral neurological assessment (NBNA) at 7 d and 28 d after birth,Bayley scales of infant development at 18 months,WPPSI-Ⅲ score at 6 years and survival were compared between the two groups.Results After treatment,there was no significant difference between the treatment group and the control group in NSE serum level (12.94±2.87 vs 13.27±3.05) and NBNA score (31.42±3.75 vs 31.81±4.02) at 7 d after birth (P>0.05,respectively).However,the NBNA score of the treatment group was significantly higher than that of the control group (35.03±2.12 vs 33.61±2.61,P=0.012) at 28 d after birth,and the mental development indexes (MDI) (91.11±15.09 vs 82.69±12.95) and the psychomotor developmental indexes (90.39±13.00 vs 81.78±14.70) in treatment group were also higher than those in the control group (P<0.05,respectively).At 6 years old,the IQ score of the treatment group was higher than that of the control group (83.58±18.92 vs 72.93±15.65,P=0.024);the number of children with IQ≤70 in the treatment group was significantly less than those in the control group (11 vs 17),and the number of children with IQ≥85 in the treatment group was significantly higher than those in the control group (18 vs 8) (P<0.05,respectively).There was no significant difference in the survival rate at 18 months (94.74% vs 88.88%) and 6 years (81.58% vs 75.00%) between the two groups.Conclusion Sub-hypothermia therapy combined with ganglioside can improve the short-term and medium-term neurobehavioral function and long-term mental development of children with HIE,which has a good prospect for application.