纳洛酮治疗重度窒息新生儿临床疗效观察

Clinical effect of naloxone in the treatment of neonatal severe asphyxia

目的观察早期（生后6小时内）应用纳洛酮治疗重度窒息新生儿的治疗作用和效果。方法将80例重度窒息新生儿随机分为对照组与治疗组。对照组患儿均按三项支持及三项对症处理，并予胞二磷胆碱、脑活素治疗。在对照组治疗基础上，治疗组生后6小时内应用纳洛酮，首剂0．1mg／kg静脉滴注，接着改为0．05mg／（kg·h），持续4～6小时，连用3天。观察两组患儿的意识、反射、肌张力恢复时间以及在不同时期的NBNA评分情况，及对所有患儿进行HIE分度。结果治疗组患儿意识、原始反射、肌张力恢复时间均短于对照组，比较有显著性差异（P〈0．05）。治疗组中、重度新生儿缺氧缺血性脑病（HIE）发生率均低于对照组，比较有显著性差异（P〈0．05）。治疗组患儿的NBNA评分在生后12～14d评分〉35分者所占百分比与照组比较有显著性差异（P〈0．05）。治疗组与对照组的存活儿在适应性、粗大运动、个人一社交比较，P值均〈0．05，差异有统计学意义。结论早期（生后6小时内）应用纳洛酮对重度窒息新生儿疗效确定，能改善重度窒息新生儿的神经系统症状，促进受损神经功能的恢复，能提高重度窒息儿近期的智力、运动发育，改善预后，减少后遗症，提高生存质量。

Objective To observe the clinical effect of the early use of naloxone（in 6 hours after born） in thetreatment of neonatal severe asphyxia. Methods 80 cases of neonatal severe asphyxia were randomly divided into two groups. The control group were received the treatment with Citicoline and Cerebrolysin, and the triad support and symptomatic therapy. And the experiment group received the treatment of naloxone in 6 hours after born in addition. The dose of naloxone began from 0.1mg/kg to 0. 05mg/（kg·h）,last for 4-6 hours for 3 days. The recovering time of consciousness, reflex, and muscle tone were observed, as well as the results of NBNA scale in different time. Results The recovering time of consciousness, reflex, and muscle tone in the experiment group were less than that of the control group, the difference was obvious （P〈0. 05）.The morbidity of moderate and severe hypoxie-ischemic encephalopathy were lower than the control group. The proportion of the cases that got more than 35 cent on the NBNA scale in the experiment group in 12-14 days after born was more than the control group（P〈0. 05）. And there were obvious differences between the two groups in the adaptability, gross motor, and sociality in the survivor. Conclusion The early use of naloxone（in 6 hours after born） in thetreatment of neonatal severe asphyxia has definite therapeutic effect, which may release the symptom of the nervous system, promote the recovery of the damage brain and the development of the intelligence and motor in the severe asphyxia infants, so as to improve the outcome of the disease and life quality.