新生儿HIE脑实质密度改变及尼莫地平干预作用

Change in density of brain parenchyma of neonates with hypoxic-ischemic encephalopathy and interventing role of nimodipine

目的探讨新生儿缺氧缺血性脑病患儿脑实质密度的改变及尼莫地平的干预作用。方法将58例中、重度缺氧缺血性脑病患儿随机分成常规治疗组28例和尼莫地平组30例。尼莫地平组患儿在常规治疗的基础上每天给予尼莫地平治疗2mg，连用10-14天。缺氧缺血性脑病患儿均于生后第3～5天及第10～14天行影像学检查。对治疗和观察结果进行统计分析。结果尼莫地平组患儿的额叶皮质处计算机断层成像值变化与常规治疗组比较差异有统计学意义（t=4．362，P〈0．01），在额叶髓质及基底神经节处计算机断层成像值变化比较差异无统计学意义（t分别为1．034、1．011，均P〉0．05）。结论尼莫地平能减轻脑损伤，且额叶皮质处脑实质密度恢复显著，提示尼莫地平对缺氧缺血性脑损伤具有保护作用；宫内缺氧影响额叶皮质发育，额叶皮质处计算机断层成像值异常与神经发育异常有关。

Objective To explore change in density of brain parenchyma of neonates with hypoxic-ischemic encephalopathy （HIE） and interventing role of nimodipine for it. Methods 58 neonates with moderate and severe HIE were randomly divided into two groups： routine treatment group （n = 28 ） and nimodipine treatment group （ n = 30）. On basis of routine treatment, 2mg/d of nimodipine was given intravenously at 0.5 - 1.0μg .kg^-1.min^-1 of infusion speed for those neonates in nimodipine treatment group for 10 - 14 days. At 3th - 5th days and 10th - 14th days after birth, all neonates with HIE received imaging examination respectively. The therapeutic effects and imaging examination were analyzed by SPSS10.0 software. Results After treatment for 10 - 14 days, in computed tomography（CT） values in cerebral cortex of frontal lobe of neonates there were significant differences between nimodipine treatment group and routine treatment group （ t =4. 362, P 〈0.01 ）. But in CT values in frontal medulla and basal ganglion, there were no significant differences between the two groups （ t = 1. 034, 1.011 respectively, both P 〉 0.05）. Conclusion Nimodipine can significantly alleviate brain damage and recovery of density of brain parenchyma in cerebral cortex of frontal lobe of neonates with HIE in nimodipine treatment group were significant, indicating that nimodipine has a protective effect on hypoxic-ischemic damage of the neonate. The severer intrauterine hypoxia influences development of cerebral cortex in frontal lobe of the neonate. Abnormal CT values in cerebral cortex of frontal lobe is related to neurodevelopmental abnormalities of neonates with HIE.