头部亚低温对新生儿缺氧缺血性脑病血浆 非蛋白结合铁和神经行为评分的影响

The changes of nonprotein-bound iron levels and behavioral neurological assessment following selective head cooling with mild hypothermia treatment in neonates with hypoxic-ischemic encephalopathy

目的探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病(HIE)对血浆非蛋白结合铁(NPBI)及神经行为评分(NBNA)的影响。方法选择2011年1月至2012年6月本院新生儿重症监护病房收治的中、重度HIE患儿。随机分为亚低温组和常规组,分别检测亚低温及常规治疗后0、24、48、72 h及7天血清NPBI浓度,比较两组患儿生后7、14及28天的NBNA评分,以及12个月时后遗症、智力发育指数(MDI)和运动发育指数(PDI)。结果两组患儿治疗开始时NPBI浓度差异无统计学意义(P>0.05),亚低温组在治疗后24、48、72 h血浆NPBI浓度分别为(5.57±0.75)μmol/L、(3.23±0.68)μmol/L、(1.94±0.58)μmol/L,明显低于常规组的(7.40±0.55)μmol/L、(5.53±0.94)μmol/L、(2.70±0.83)μmol/L,差异有统计学意义(P均<0.05)。生后7天两组患儿NBNA评分比较差异无统计学意义(P>0.05),生后14天、28天亚低温组NBNA评分明显高于常规组[14天:(34.0±2.2)比(31.2±2.5),28天:(36.0±1.8)比(34.2±1.5)],差异有统计学意义(P<0.05)。生后12个月,亚低温组患儿MDI及PDI均优于常规组[MDI:(96.2±16.3)比(85.8±8.9),PDI:(88.9±12.6)比(74.3±14.1)],差异有统计学意义(P<0.05);亚低温组后遗症发生率11.8%,常规组后遗症发生率34.4%,差异有统计学意义(P<0.05)。结论 HIE患儿应用选择性头部亚低温治疗后血浆NPBI释放减少,氧化应激损伤减轻,有明显的神经保护作用。

Objective The study examined the changes of nonprotein-bound iron （NPBI）levels and neonatal behavioral neurological assessment （NBNA） score, following selective head cooling with mild hypothermia （SHC）treatment in neonates with hypoxic-ischemic encephalopathy （HIE）. Methods Patients studied were from our hospital NICU between January 2011 and June 2011. Neonates with moderate or severe HIE were randomly assigned to SHC group （34 cases ） and to conventional management group （32 cases）. In both groups, serum levels of NPBI 0 h, 24 h,48 h,72 h,7 d were measured after treatment, and compared the NBNA score after birth 7 d, 14 d, 28 d. Results There was no statistical significance of serum levels of NPBI at the beginning of treatment （ P 〉 0. 05 ）. For the SHC group, 24 h,48 h,72 h serum levels of NPBI were respectively （5.57 ±0. 75）μmol/L, （3.23±0. 68） μmol/L, （ 1.94 ±0. 58 ） μmol/L after threatment, significantly lower than the conventional group （ 7.40±0. 55 ） μmoL/L, （ 5.53 ±0. 94 ） μmol/L, （ 2. 70 ± 0. 83 ） p^mol/L. The difference was statistically significant （ P 〈0.05 ）. 14 d and 28d after birth NBNA score of the SHC group was respectively（34. 0 ± 2. 2） and （ 36.0 ± 1.8 ）, significantly higher than the conventional group - （ 31.2 ± 2.5 ） and （ 34.2± 1.5 ）. The difference was statistically significant （P 〈 0. 05）. 12 months after birth, children with mild hypothermia group mental development index （MDI） （96. 2 ± 16. 3 ） and psychomotor development index （PDI） （88.9 ± 12. 6） was better than that of the conventional group MDI （85.8 ± 8.9 ）and PDI（74. 3 ± 14. 1 ）. The difference was statistically significant （ P 〈 0. 05 ）. For the SHC group, the incidence of neurological sequela was 11.76% , conventional group sequela incidence was 34. 37% , and the outcome of the two groups showed significant difference （ P 〈 0.05 ）. Conclusions Mild hypothermia treatment can reduce the release of NPBI, inhibit the production of oxygen free radicals and the lipid peroxidation reaction, reduce ischemia-reperfusion injury after oxidative stress, and has a neuroprotective role.