选择性头部亚低温治疗新生儿缺氧缺血性脑病的安全性

Safety of Selective Head Cooling with Mild Systemic Hypothermia after Neonatal Encephalopathy

目的研究选择性头部亚低温（SHC）治疗新生儿缺氧缺血性脑病（HIE）的安全性。方法收集不同严重程度的新生儿HIE共54例。至入院96h有效病例41例，随机分为SHC组和对照组（SHC组21例、对照组20例）。SHC组患者生后〈6h开始给予SHC治疗，鼻咽部温度维持在（34±0．2）℃，直肠温度维持〉34．5℃，持续72h，然后自然复温；对照组患者直肠温度维持36～37．5℃。进行心电图、血压、经皮氧饱和度、鼻咽部温度和直肠温度监测。观察主要不良反应：病死率、严重心律失常、静脉血栓或出血、难以纠正的低血压。结果SHC组和对照组的病死率分别为9．52％（2／21例）和15％（3／20例）。死亡者均为重度HIE。2组均无出现严重心律失常、低血压和肾功能衰竭。结论SHC72h治疗新生儿HIE是可行和安全的。

Objective To study the safety of selective head cooling（SHC） with mild systemic hypothermin in neonates with hypoxic-ischemic encephalopathy （HIE）. Methods Fifty-four term infants with various severity of neonateal encephalopathy were randomly assigned to either head cool（n= 27） or control group（n=27）. 41 infants were admitted in 96 h（SHC n=21, control group n=20）. In head cooling group, the nasopharyngeal temperature was maintained at （34±0. 2）℃ and rectal temperature maintained at 34～35 ℃ for 72 h, then rewarmed spontaneously. In control group, normal rectal temperature was maintained. During study period, the babies in both groups were given mornitoring of nasopharyngeal temperature, heart rate, respiratory rate, transcutaneous arterial oxygen saturation and blood pressure. Severe adverse events were recorded which included death, major cardiac arrhythmia, major venous thrombosis or hemorrhage and severe hypotension despite full support. Results. The major cause of death was severe HIE and respiratory failure[9.52% （2/21） in cooling vs 15% （3/20） in control group, P=0. 518]. The rate of abnormal renal funtion, severe hypotension and major cardiac arrthymia were not significantly different between two groups. Conclusion These data suggest that selective head cooling with mild systemic hypothermia in neonates with HIE is safe during first 72 h therapy.