选择性头部降温治疗新生儿缺氧缺血性脑损伤的初步评价

Neuroprotection of selective brain hypothermia to neonates with the hypoxic-ischemic brain damage

目的 研究选择性头部降温对足月新生儿窒息后缺氧缺血性脑损伤 (hypoxic ischemicbraindamage ,HIBD)治疗的安全性和神经保护作用。方法 将 18例中重度窒息的足月新生儿随机分为治疗组 (11例 )和对照组 (7例 )。治疗组采用选择性头部降温方法 ,维持鼻咽温度为 (34 0± 0 2 )℃ ,持续 72h ;对照组不进行降温治疗。于生后 6 2～ 72h采血检测肌钙蛋白 T、β2 微球蛋白、D 二聚体 ,同时检测尿 β2 微球蛋白和脑脊液 (CSF)神经烯醇化酶 (NSE)等。于治疗前、生后 7～ 10d和生后 3个月进行常规 16导联EEG检测 ,并分别采用新生儿神经行为评分 (NBNA)、婴幼儿发育量表 (CDCC)进行神经行为发育评价。结果 治疗组NSE为 (18 1± 2 1) μg/L ,对照组为 (2 4 6± 5 3) μg/L(t =2 0 4,P <0 0 5 ) ;治疗组患儿生后 2 8dNBNA为 (37± 2 )分 ,对照组为 (32± 3)分 (t =1 83,P <0 0 5 )。两组患儿血 β2 微球蛋白、肌钙蛋白 T、D 二聚体以及尿 β2 微球蛋白均明显升高 ,但两组差异无显著性(P均 >0 0 5 )。结论 初步研究显示 ,选择性头部降温对足月窒息新生儿具有神经保护作用 ,体温维持 34 5℃以上是安全的。

Objective To study the safety and neuroprotection of selective brain hypothermia in term neonates with hypoxic ischemic brain damage after birth asphyxia. With the parental approval, eighteen newborns (gestation ≥37 weeks, Apgar score ≤5 after 5 min) with clinical evidence of encephalopathy and abnormal EEG were enrolled in the first 6 h after birth. Methods Infants were divided randomly into the control group[rectal temperature(36.5±0.5)℃, n =7]and the treatment group[rectal temperature (34.5±0.3)℃, nasopharyngeal temperature (34.0±0.2)℃, n =11]. The head hypothermia in the treatment group was induced by circulating water cooling cap for up to 72 h. Blood samples were taken 72 hours after birth and analyzed for D dimer,troponin T and β 2 microglobulin (β 2 MG). The cerebrospinal fluid samples were detected for neuron specific enolase (NSE). A 16 channel EEG was recorded 4 6 hours, 7 10 days and 3 months after birth. Neurodevelopmental assessment was evaluated with neonatal behavioral neurological assessment (NBNA) 1, 3 and 6 months after birth. Results A significant elevation in plasma D dimer,troponin T and β 2 MG was observed in both groups ( P >0 05), but NSE in the control group was higher than in the treatment group [(24.6±5.3) μg/L vs (18.1±2.1) μg/L, t =2.04, P <0.01].In the treatment group NBNA was improved 28 days after birth compared to the control group ( t =1.83, P <0.01).EEG was normal in the treatment group 7 days after birth. Conclusions The neuroprotection of selective hypothermia could be tracked by the neurodevelopmental, biochemical, and EEG measures. The adverse effect on cardiac, kidney and coagulation function were slight in term newborns.