亚低温治疗新生儿缺氧缺血脑损伤临床安全性评价

Neuroprotection of Hypothermia in Full Term Neonates After Asphyxia: a Safety Study

目的 研究亚低温治疗新生儿窒息后缺氧缺血脑损伤 (hypoxic ischem ic brain dam age,HIBD)的安全性。 方法 1999年 7月～ 2 0 0 0年 7月本院 NICU收治的 2 4例中重度窒息足月新生儿 ,出生体重 (32 0 0± 6 0 0 ) g,Apgar评分 5 min<5分 ;生后 6 h内存在脑电图异常和 (或 )临床神经系统症状和体征 ,分为治疗组 (11例 )和对照组 (13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± 0 .2 0 )℃ ,持续 72 h;对照组不进行亚低温治疗。新生儿生后 6 2～ 72 h采血检测肌钙蛋白T、肌酐、尿素氮、β2 微球蛋白、肝功能、出凝血时间、D-二聚体 ,同时检测尿 β2 微球蛋白等。 结果 治疗组患儿未发生硬肿、呼吸暂停、心律失常、低血钾、低血钠等 ,两组患儿血 β2 微球蛋白、肌钙蛋白 T、D-二聚体 ,以及尿 β2 微球蛋白明显升高 ,两组差异无显著性 (P均 >0 .0 5 )。 结论 采用选择性头部降温方法治疗新生儿 HIBD是可行的 ,将体温维持在 34 .5℃左右 ,对窒息新生儿的心、肾、肝、凝血及代谢功能无不良影响 。

Objective To study the safety of hypothermia in neonates with hypoxic-ischemic brain damage after asphyxia. Methods Twenty four full term newborns with Apgar score <5 at 5 minutes after birth, encephalopathy and/or abnormal EEG during 4 to 6 hours after birth were randomly asigned to either no cooling group [controls: rectal temperature=(36.5±0.5)℃,n= 7], or cooling group [rectal temperature=(34.5±0.3)℃, nasopharyngeal temperature=(34.00± 0.20)℃,n=11].Head cooling was induced by circulating water for up to 72 hours. Blood samples were analyzed for D-dimer, Troponin-T and β 2 MG at 72 hours after birth. Results Elevation of D-dimer, Troponin-T and β 2 MG was shown in plasma of cooling vs. controls, but the difference between two groups was not significant (P>0.05). Conclusions The results suggest that the selective head cooling in full term newborn has no significant adverse effect on cardiac function, kidney function and coagulation function.