NBNA加分法对新生儿窒息预后早期评估的临床研究

Clinical Study of Prognostic Evaluation by NBNA Count Methods in Anoxia Newborn During Earlier Period

目的探讨NBNA加分法对新生儿窒息预后评估的临床意义。方法对180例本院和中山大学附属第一医院新生儿监护病房(NICU)住院的窒息儿分别于出生后3～5天、12～14天进行NBNA加分法评估,观察其与窒息和HIE程度的相关性。对其中基础分<35分共110例患儿自恢复期起随机分成干预组和对照组,于生后12月龄时进行智能发育随访。结果NBNA加分法评分值:重度窒息组<中度窒息组<轻度窒息组(P均<0.05)。头颅CT结果为HIE者107例,占97.3%,3例(2.7%)头颅CT结果正常。且NBNA加分法评分基础分<35分的患儿,存在后遗症者9例,其中7例为外加分<2分,另2例加分2～3分;加分>3分者无1例发生后遗症;NBNA基础分>35分者无1例出现后遗症。干预组后遗症发生率明显降低。结论NBNA加分法对新生儿窒息预后的早期评估较窒息分度为佳,与头颅CT结合能较好地作为窒息儿脑损伤早期干预的指征。早期干预能有效地降低脑损伤的致残率。

Objective To study the clinical significance of NANB count methods for the evaluation of prognosis in anoxia newborn. Methods We have evaluated 180 anoxia newborns with the NBNA count method 3 to 5 days and 12 to 14 days after labor respectively in the neonatal ICUs of the Tai-ping People's Hospital and the First Affiliated Hospital of Sun Yat-sen University and observed the correlation between the NBNA method and anoxia and HIE. Among the 110 cases whose basic value was lower than 35, intervention and control groups were adopted randomly after recovery. And intelligence growth test was made for them at the age of 12months. Results Among the NBNA values, the severe anoxia group was lower than the mild anoxia group, and anoxia group was lower than the mild one(both p<0.05). The CT skull scan showed HIE in 107 cases, which was 97.3% of the total. And 3 cases, that is 2.7% of the total, showed normal. In the babies whose basic value was lower than 35, sequela were fond in 9 cases. Among them, 7 cases had extra value lower than 2, the other 2 cases had the extra value between 2 and 3. No sequela were found in cases whose extra value was higher than 3 or whose basic value was higher than 35. The incidence of sequela was obviously reduced in intervention group. Conclusions The NBNA count method is better than Asphyxia Gradation method in the early evaluation for the prognosis of newborn anoxia. Combined with the CT skull scan, it can be a good indication for early intervention for the brain injury of anoxia. Early intervention can decrease the incidence of disability effectively for brain injury.