不同压力高压氧治疗对新生儿HIE疗效观察

Efficacy of hyperbaric oxygen therapy under different pressures on neonatal hypoxic-ischemic encephalopathy

目的研究发现高压氧(HBO)可以降低新生儿缺氧缺血性脑病(HIE)的伤残率和病死率,因而用于HIE的治疗,但临床报道所使用的治疗压力及疗效各不相同。该文通过观察HBO治疗前后机体氧化、抗氧化水平变化,脑血管舒缩调节因子和神经行为评分(NBNA)的变化,探讨不同压力HBO治疗对HIE的疗效。方法随机将收治的60例HIE患儿按所使用的治疗压即绝对压(ATA)的不同分别分1.4ATA,1.5ATA,1.6ATA三组,采用不同压力HBO治疗,每天1次,7d为一疗程。各组均在HBO第一次治疗前和最后一次治疗后,测血清MDA,SOD,NO,NOS,查NBNA和眼底。结果3组不同压力HBO治疗前后患儿血清MDA,SOD,NO,NOS比较,差异有显著性意义(P<0.01);1.4ATA和1.6ATA高压氧治疗后患儿血清MDA,SOD,NO,NOS比较,差异有显著性(P<0.05)。3组治疗前后患儿NBNA比较,差异有显著性意义(P<0.05)。3组不同压力HBO治疗前后患儿眼底检查无异常。结论1.4ATA,1.5ATA,1.6ATA3组压力HBO综合治疗新生儿缺氧缺血性脑病过程中,随着压力的增高机体抗氧能力逐渐增强,至1.6ATA时MDA均值最低,SOD均值最高。NO,NOS含量较治疗前下降。3组压力的HBO综合治疗HIE均安全、有效。

Objective Some research has shown that hyperbaric oxygen （HBO） can decrease the rate of mortality and disability caused by hypoxic-ischemic encephalopathy （HIE） in neonates. However, the HBO pressure used in the clinical reports and the efficacy of HBO are different. This study was designed to investigate the efficacy of HBO therapy under different pressures by observing the changes of peroxidation, antioxidant levels and brain vasomotor regulation factors as well as the score of neonatal behavioral neurological assessment （NBNA） in neonates with HIE after HBO therapy. Methods Sixty neonates with HIE were randomly administered with 1.4, 1.5 or 1.6 atmosphere absolute （ ATA ） of HBO, once daily for seven days. Serum levels of malondialdehyde （MDA） , superoxide dismutase （SOD） , nitric oxide （NO） and nitric oxide synthase （NOS） were measured before and after HBO therapy. Meanwhile, NBNA and eye ground examination were performed. Results Serum SOD level increased and serum levels of MDA, NO and NOS decreased significantly after HBO therapy in the three HBO therapy groups （ P 〈0.01 ）. Serum SOD level was significantly higher and serum levels of MDA, NO and NOS were significantly lower in the 1.6 ATA HBO group than those in the 1.4 ATA group after therapy （P 〈 0.05）. The 1.6 ATA HBO group also showed increased SOD and decreased MDA levels compared with the 1.5 ATA HBO group after therapy （ P 〈 0.05 ）. NBNA scores in the three groups increased significantly after HBO therapy （ P 〈 0. 05 ）. None of the three HBO therapy group patients showed abnormal eye grounds after therapy. Conclusions HBO therapy with 1.4, 1.5 or 1.6 ATA is safe and effective for neonatal HIE. The antioxidant capacity increases with the increasing HBO pressure in neonates with HIE.