高压氧早期干预对围产期缺氧缺血性脑病新生儿预后的影响

Effect of early intervention of hyperbaric oxygenation on prognosis of perinatal neonates with hypoxic ischemic encephalopathy

目的:观察高压氧早期干预对围产期缺氧缺血性脑病新生儿预后的影响,探讨新生儿缺氧缺血性脑病后遗症的有效防治方法。方法:将2002年1月～2005年10月湖北省中山医院新生儿科住院确诊的新生儿缺氧缺血性脑病患儿84例随机分为对照组和治疗组。两组早期均给予常规3项支持和3项对症治疗,并使用脑活素。治疗组在此基础上给予高压氧治疗2疗程。新生儿期采用中国新生儿20项行为神经评分法,对所有患儿分别于治疗前及治疗1疗程后各测1次行为神经评分(NB-NA);随访12个月期间复查颅CT、观察运动发育情况、测查Gesell智能发育商。结果:82例患儿坚持随访12个月。①治疗前两组NBNA评分无明显差别,治疗后治疗组评分明显高于对照组(38.8±2.3,34.6±2.2,P<0.01);②治疗组脑发育不良发生率为7.14%(3/42),明显低于对照组25.0%(10/40),P<0.05。③两组智能发育商得分:治疗组动作能评分较对照组明显提高(106.8±10.3,89.8±11.1,P<0.01),应物能明显提高(102.3±11.6,87.7±11.9,P<0.01),应人能明显提高(105.6±11.4,90.2±11.3,P<0.01),言语能明显提高(98.8±11.9,91.6±10.3,P<0.01)。结论:高压氧早期干预治疗能促进脑发育,提高新生儿行为神经评分和智能发育商,改善新生儿缺氧缺血性脑病的预后。

Objective： To observe the effect of early intervention of hyperbaric oxygenation （HBO） on prognosis of perinatal neonates with hypoxic ischemic encephalopathy （HIE）, and explore the effective prevention and cure methods of sequelae related to HIE. Methods ： 84 neonates with HIE who were hospitalized and diagnosed at the Department of Neonatology, Zhongshan Hospital from January 2002 to October 2005 were selected and divided into control group and treatment group randomly. The neonates in the two groups were given routine three items of maintenance treatment, three items of symptomatic treatment and cerebrolysin treatment at early stage. On the basis of basic treatment, the neonates in treatment group received two courses of HBO treatment, then neurological assessment was conducted before treatment and one course after treatment by Chinese twenty items of Neonatal Behavioral Neurological Assessment （NBNA） scale. All the neonates were followed up for 12 months, and cranial CT reexamination was carried out, motion development was observed and Gesell intelligence DQ was checked. Results： 82 neonates were followed up for 12 months. There was no significant difference in NBNA score before treatment between the two groups, but after treatment, NBNA score in treatment group （38.8 ± 2. 3） was significantly higher than that in control group （34. 6±2.2） （P 〈0. 01 ） . The incidence of cerebral dysplasia in treatment group was 7. 14% （3/42）, which was significantly lower than that in control group （25.0% , 10/40, P 〈0. 05） . The scores of intelligence DQ in the two groups： the score of action a- bility in treatment group was significantly higher than that in control group （ 106. 8 ± 10. 3, 89. 8 ± 11. 1, P 〈 0. 01 ） ; the ability responding to object in treatment group was significantly higher than that in control group （ 102. 3± 11.6, 87.7± 11.9, P 〈 0. 01 ） ; the ability responding to human in treatment group was significantly higher than that in control group （ 105.6 ± 11.4, 90. 2± 11.3, P 〈0. 01 ） ; language ability in treatment group was significantly higher than that in control group （ 98.8± 11.9, 91.6 ± 10. 3, P 〈0. 01 ） . Conclusion： Early intervention of HBO can promote cerebral development, raise neonatal NBNA score and intelligence DQ, and improve ：he prognosis of neonates with HIE.