新生儿缺氧缺血性脑病十年回顾

A Long-term Follow-up of Neonatal Hypoxic-ischemic Encephalopathy

目的 总结我院 10年来新生儿缺氧缺血性脑病 (HIE)的临床特点和预后 ,探讨改善预后的措施。 方法 对 115 0例 HIE患儿的临床资料和随访结果进行回顾性分析。 结果 115 0例HIE中足月儿 942例 (81.9% ) ,早产儿 2 0 8例 (18.1% ) ,病因以宫内窘迫和产时窒息为主 ,75 .0 %合并颅内出血。病死率 7.0 % (重度 HIE32 .8% ,中度 4.2 % ,轻度 0 )。随访 85 2例 ,后遗症发生率 10 %(重度 HIE6 0 .7% ,中度 4.5 % ,轻度 0 )。早产儿 HIE预后差 ,中度预后不良占 37.0 % ,重度 10 0 %。改善预后的措施 :(1)早诊早治。 (2 )把维持机体内环境的稳定放在治疗 HIE的首位 ,坚持三个维持 ,三个对症原则。 (3)保护脏器功能 ,积极治疗多脏器损害。 (4 )对重度 HIE采用高压氧加长疗程 (4～ 6个月 )治疗 ,可使后遗症发生率降至 2 7.8% ,与常规疗法组比较 ,差异有非常显著性 (P<0 .0 1)。 (5 )早随访 ,早干预。 结论 重度 HIE和早产儿 HIE预后差 。

Objective To study the clinical characteristics and long term prognosis of the neonates with hypoxic ischemic encephalopathy (HIE) and explore therapy to improve the prognosis. Methods Data of 1150 newborns with HIE were analyzed. retrospectively. Results There were 942 full term babies(81.9%) and 208 prematures(18.1%). Most of them were caused by anoxia occurring in intrauterine period or at birth, 75.0% of them with superimposed intracranial hemorrhage. The mortality rate was 7.0%(32.8% severe HIE, 4.2% moderate HIE). Among 852 surviors with follow up, the sequenlae rate is 10%(60.7% in severe HIE,4.5% in moderate HIE). The prognosis were bad. The therapy to improve the prognoses are as follow:(1)Early diagnosis and clinical intervention.(2)To maintein the hemostasis is the major principle of treatment.(3)To prevent organ function damage.(4)Long term(4 to 6 months) of Hyperbaric oxygen therapy should be applied to newborns with severe HIE.(5)Early follow up from newborn period and preventive intervention. Conclusion Prognoses of both newborn with sever HIE and prematures are bad. Long term treatment after newborn period is necessary to improve the prognosis.