生后6～12h开始亚低温治疗对新生儿缺氧缺血性脑病预后的影响

Effect of head mild hypothermia during 6-12 h after birth treatment on the prognosis of neonatal hypoxic-ischemic encephalopathy

目的 探讨生后6～12h开始选择性头部亚低温治疗对新生儿缺氧缺血性脑病（HIE）预后的影响,为亚低温治疗新生儿HIE适宜的治疗时间窗提供更多的理论及临床依据.方法 选择2008年6月至2011年6月入住南方医科大学附属花都人民医院新生几重症监护病房的中度缺氧缺血性脑病新生儿40例,随机分为亚低温治疗组（观察组）和常规治疗组（对照组）,分别检测治疗开始后0、24、48、72 h和7d时外周血清中的神经元特异性烯醇化酶（NSE）浓度,比较两组患儿生后7、14及28 d的NBNA评分.患儿在出院后3、6个月时回院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 两组患儿治疗开始时NSE浓度比较差异均无统计学意义（P＞0.05）.观察组（22例）在治疗后24、48、72 h血浆NSE浓度分别为（34.5 ±4.7）、（25.5±3.5）、（19.6±4.0） μg/L,明显低于对照组（18例）的（42.7±4.5）、（42.6±4.0）、（37.0±4.5）μg/L,治疗7d两组NSE浓度比较差异无统计学意义（P＞0.05）.生后7d两组惠儿NBNA评分比较差异有统计学意义（P＜0.05）,生后14、28 d观察组NBNA评分明显高于对照组,差异有统计学意义（P＜0.05）.两组患儿的MDI分别为73.2±11.2、80.7±10.3,PDI分别为77.2±9.3、84.5 ±10.2,两组比较差异有统计学意义（P＜0.05）.结论 中度缺氧缺血性脑病新生儿生后6～12h开始选择性头部亚低温治疗仍可有不同程度的神经保护作用.

Objective To investigate the effect of selective head mild hypothermia （SHMH） on the prognosis of newborn hypoxic ischemic encephalopathy （HIE） during 6-12 hours after birth,and provide more theories and clinical basis for perfect time window of mild hypothermia treatment of HIE in neonates.Methods Forty full-term infants with moderate HIE within 12 hours after birth were divided into two groups：the treatment group （treated by SHMH during 6-12 hours after birth,22 cases） and the control group （18 cases）.All infants received the same therapy during hospitalization.The treatment group was treated by SHMH for 72 hours,after discharge,all of the inpatients followed up at the age of 3 month and 6 month,for evaluation of Mental Development Index （MDI） and Psychomotor Development Index （PDI） designed by the standardization Child Development Center of China （CDCC）.Results The MDI of them was respectively 73.2 ± 11.2,80.7 ± 10.3.The PDI of them was respectively 77.2 ± 9.3,84.5 ± 10.2.There was statistical significance between them.Conclusions The treatment of moderate HIE with SHMH during 6-12 hours after birth is effective with the function of nervous protection.