新生儿缺氧缺血性脑病后续治疗观察研究

The observation of continuing treatment on newborns with hypoxic and ischemic encephalopathy

目的 探讨新生儿期后丽珠赛乐、胞二磷胆碱和高压氧治疗中、重度新生儿缺氧缺血性脑病（HIE）的疗效及对预后的影响。方法 62例中、重度缺氧缺血性脑病病人在新生儿早期严格按全国新生儿缺氧缺血性脑病协作组治疗方案治疗，满月后随机分三组：治疗1组丽珠赛乐5ml／d，胞二磷胆碱0．125g／d，静脉滴注，1次／d，连续10d，每月1疗程，共3～5个疗程；治疗2组除上述治疗外，同时予高压氧治疗，每月10d，共3～5疗程；对照组不予活脑药及高压氧治疗；所有病例定期随访1年，均给与指导喂养、早期干预，1岁时用0～6岁儿童神经心理量表进行智能评估。结果 治疗2组发育商（98．4±8）〉治疗1组发育商（103．4±5）〉对照组（86．4±9），差异具有统计学意义（P〈0．05或P〈0．01）。后遗症发生率治疗1组（8．33％）、治疗2组（7．69％）较对照组（50％）明显降低（P〈0．05）。结论 缺氧缺血性脑病新生儿期后丽珠赛乐、胞二磷胆碱和高压氧治疗可减少神经系统后遗症的发生，明显改善中、重度HIE的预后。

Objective To investigate the curative effect of cerebrolysin plus cyticholine and hyperbaric oxygen treatment on post-neonate newborns with moderate and severe hypoxic and iscbemic encephalopathy （HIE）and its effect on the prngnosis.Methods 62 patients,who were treated according to the treatment scheme of national cooperation group on newborns with HIE, were divided into three groups after being one month old： treatment group 1 ： cerebrolysin 5 ml/d plus cyticholine 0.125g/d, intravenous by drip, once a day for 10 consecutive days, one course every month for 3 - 5 courses;3 - 5 course of hyperbaric oxygen treatment with each course being 10 consecutive days plus the medicine given above for treatment group 2;no brain-nourishing medicines and hyperbaric oxygen treatment for control group;all the patients, who were foUowed up for 1 year, were given instructed feeding, early intervention and were assessed intellectually in accordance with neurological psychology quantification table for children of 0- 6 years. Results The development quotient for treatment group 1 was （98 ± 8） ; the development quotient for treatment group 2 was （103 ± 5） ,which was significantly higher than control group（86 ± 9） with P 〈 0.01 ,the incidence of sequelae for groupl and group 2 were 8.33% and 7.69% respectively, which were remarkably lower than control group（50% ）with P 〈 0.05. Conclusion The treatment of cerebrolysin plus cyticholine andhyperbafic oxygen, which can lower the incidence of sequelae of nervous system for post-nconate newborns with HIE. remarkably improve the prognosis of newboms with moderate and severe HIE.