早期不同时间窗干预对新生儿缺氧缺血性脑病预后影响的研究

Neonatal hypoxic-ischemic encephalopathy:effect and prognosis of early intervention at different time window

目的探讨不同时间窗治疗新生儿缺氧缺血性脑病(HIE)对神经系统预后的影响,为减少HIE神经系统后遗症的发生提供理论与临床依据。方法回顾性分析131例中度HIE患儿,根据就诊时间分为对照组(生后24～72 h就诊)和试验组(生后24 h内就诊),试验组根据就诊时间分为3个亚组,Ⅰ组(6 h之内),Ⅱ组(6～12 h),Ⅲ组(12～24 h)。每组患儿入院后给予相同的干预治疗,出院后于3、6月龄来我院采用中国标准化的贝来量表(CDCC)测智力发育指数(MDI)和运动发育指数(PDI)。结果对照组32例;试验组99例,其中Ⅰ组33例,Ⅱ组35例,Ⅲ组31例。(1)各组患儿MDI分别为66.9±12.3、79.7±11.4、71.4±10.0、68.0±11.4,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。(2)各组患儿PDI分别为70.8±11.6、83.7±10.6、75.8±11.3、72.4±12.3,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。结论不同时间窗开始治疗HIE的预后明显不同,6h内开始治疗的患儿其预后明显优于6h后开始治疗的患儿。提示HIE临床最佳治疗时间窗可能为6h内。

Objective To discuss the prognosis and the significant difference of the nervous system, as the result of therapy of neonatal hypoxic-ischemic encephalopathy （HIE） instituted at different time window. The findings might have clinical application in reducing CNS sequele. Methods Retrospective study of 131 inpatients with moderate HIE in the Hospital was done. They were assigned into control group （hospital admission within 24-72 hours after birth） and experimental group （hospital admission within 24 hours after birth）. There were 32 babies in the control group, and the experimental group （99 babies） was assigned into 3 subgroups according to the admission time. There were 33 babies in group I （less than 6 hours after birth） ; and 35 babies in group 1I （6 to 12 hours after birth） ;31 babies in group In （12 to 24 hours after birth）. Each group received the same intervention therapy during hospitalization. After discharge, all of them these inpatients followed up at the age of 3 months and 6 months, for evaluation of Mental Development Index （MDI） and Psychomotor Development Index （PDI） designed by the standardization Child Development Center of China （CDCC）. Results （ 1 ） The MDI of each group is respectively 66. 9 ± 12.3, 79. 7 ± 11.4, 71.4 ± 10. 0, 68.0± 11.4, the MDI of group I is the highest, and there is statistical significance between them. But there was no statistical significance between group Ⅱ , group Ⅲ and the control group. （2） The PDI of each group was respectively 70. 8 ± 11.6, 83.7 ± 10. 6, 75.8 ± 11.3, 72. 4 ± 12. 3, the PDI of group I was the highest, and there was statistical significance between them. But there was no statistical significance between group Ⅱ , group Ⅲ and the control group. Conclusion There was significant difference in the prognosis when HIE therapy was initiated in different time window. The prognosis when HIE therapy was initiated within 6 hours was better than that after 6 hours. It is reasonable to suggest that the best time window for initiation of HIE therapy maybe within 6 hours.