选择性头部亚低温对新生儿缺氧缺血性脑损伤的治疗作用

Effect of Selective Brain Hypothermia on Neonatal Hypoxic-Ischemic Brain Damage

目的探讨选择性头部亚低温对足月新生儿窒息后缺氧缺血性脑损伤（ＨＩＢＤ）的神经保护作用及其安全性。方法 将２２例重度窒息足月新生儿随机分为治疗组（１１例）和对照组（１１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７２ ｈ；对照组不进行降温治疗。两组均于治疗后６４～７２ ｈ测脑脊液神经元特异性烯醇化酶（ＮＳＥ），血ＣＫ－ＭＢ，尿β２微球蛋白（β２－ＭＧ）等。于治疗前、生后１０ ｄ和３个月进行常规１６导ＥＥＧ检测，并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 治疗组脑脊液ＮＳＥ为（１９．５±２．２）μｇ／Ｌ，明显低于对照组[（２４．６±５．３）μｇ／Ｌ］（Ｐ ＜ ０．０１）；生后２８ ｄ治疗组ＮＢＮＡ评分为（３６±３）分，低于对照组[（３２±２）分］（Ｐ ＜ ０．０１）。治疗前两组ＥＥＧ均异常，生后１０ ｄ，３个月治疗组ＥＥＧ均正常，对照组２例持续重度异常。两组患儿血ＣＫ－ＭＢ及尿β２－ＭＧ差异无显著性（Ｐ ＞０．０５）。结论选择性头部亚低温对足月新生儿窒息后ＨＩＢＤ可能具有神经保护作用，临床上具有安全性。

Objective To study the clinical safety and neurop rotection of selective brain hypothermia for full-term neonates with hypoxic-i sch emic brain damage(HIBD) following perinatal asphyxia. Methods Twenty-two severe asyxiated neonates were randomly assigned into the treatment group(n=11) a nd the control group(n=11). Besides the routine treatment, brain hypothermia was us ed in the treatment group and their nasopharyngeal temperature was maintained a t(34.0±0.2)℃for 72 hours. The control group neonates received routine treatment. Neuron-specific enolase(NSE) in the cerebrospinal fluid(CSF), serum CK - MB a nd urine β2-microglobulin(β2-MG) were measured in the two groups between 6 4 and 72 hours after the treatment. EEG was recorded at 6 hours, 10 days and 3 months af ter birth. Neurodevelopmental assessment was done with neonatal behavioral neurological assessment(NBNA) at 10 and 28 days of life and with CDCC at 3 months after birth. Results NSE in the control group was higher than that in the tre atment group [(24.6±5.3) μg/L vs(19.5±2.2)μg/L](P < 0.01). NBNA of t he treatment group(36±3) sh owed improvement at 28 days after birth compared with that in the control group (32±2)(P < 0.01). In the treatment group, EEG normalized at 10 days and 3 months after birth respectively. However,EEG of 2 patients in the control group remai n ed abnormal. Serum CK-MB and urine β2-MG were elevated in the 2 groups, but no significant difference was noted. Conclusions Selective brain hypothermia may be useful and safe for neuroprotection in full-term neonates with HIBD following perinatal asphyxia .