全身亚低温治疗新生儿窒息的安全性评价

Study on Safety of Treatment with Systemic Mild Hypothermia for Neonatal Asphyxi a

目的 探讨全身亚低温治疗对新生儿的不良影响 ,评价亚低温治疗新生儿窒息的安全性。方法 将中重度窒息足月新生儿 2 4例随机分为亚低温治疗组和常规治疗对照组各 12例 ,亚低温治疗组维持肛温在 3 3～ 3 4℃ 72h ,其他治疗措施与对照组相同。两组均连续进行监护和生化指标检测 ,记录临床症状及体征。结果 两组均无出血、严重感染及死亡。亚低温组治疗期间心率平均下降 3 0次 /min ,血压及呼吸未见明显改变 ,未发现与亚低温相关的心律失常及肺动脉高压。其凝血酶原时间及凝血酶时间与治疗前及对照组相比无明显差异。血钠、血钾、血钙在低温治疗后与治疗前及对照组相比无明显差异。窒息新生儿治疗前均有代谢性酸中毒 ,部分患儿有急性肾功能异常 ,治疗后均逐渐纠正 ,亚低温组与对照组相比无明显差异。结论 全身亚低温治疗无严重的不良反应 ,在严密监护下用于足月新生儿窒息的治疗是安全可行的。

Objective To study the side effects of systemic hypothermia on newborns with asphyxia and evaluate the safety of systemicmild hypothermia treatment. Methods Twenty-four infants with moderateor severe asphyxia were randomly divided into e ither systemic hypothermia group (n=12)and normal control group (n=12). The infants in hypothermia group were induced and maintained rectal temperature 33.0～34.0 ℃ for 72 h by cooling device. The supportive treatments were same in both groups.The symptoms and signs were monitored and recorded in both groups. Results Heart rate decreased about 30 beats per min in hypothermia group,there were no hypothermia related changes in breath rate and blood pressure during treatment. Hypothermia associated cardiac arrhythmia,cli- nical signs of pulmonary hype rtension were not observed. The coagulation tests showed that there were no sig nificant differences between hypothermia and control groups. There were no signi ficant hypothermia related blood electrolytes changes. All asphyxia infants had metabolic acidosis and part of them with acute renal failure before treatment an d were recovered after supportive treatment in both groups. No hypothermia relat ed acidosis or renal failure.Conclusions Systemic mild hypothermia related side effects in t erm-asphyxiated newborns are less than expected. It indicates that systemic mild hypothermia is a stable, well-tolerated method for treating the term asphyxiate d newborns. J Appl Clin Pediatr,2005,20(2):118-120