高压氧治疗新生儿缺氧缺血性脑病疗效观察

Effect of hyperbaric oxygenation in treatment of neonatal hypoxic ischemic encephalopathy.

目的 为评价高压氧 (HBO)对新生儿缺氧缺血性脑病 (HIE)的确切疗效 ,尤其是远期效果。方法 140例 HIE患儿随机分为 HBO治疗组 78例 (简称治疗组 )和对照组 6 2例。两组均给予相同的综合治疗 ,治疗组加用 HBO治疗。存活病例随访至 1～ 4岁。采用国内 CDCC量表测定智商。同时进行体格发育和神经系统、视力及听力检查。结果 中、重度患儿 ,治疗组神经系统症状消失平均天数短于对照组 3d以上 (t=5 .78,P<0 .0 1)。治疗组随访 72例 ,康复 6 3例 ,后遗症 8例 ,死亡 1例。对照组随访 5 5例 ,康复 42例 ,后遗症 10例 ,死亡 3例。两组轻度患儿均无死亡及后遗症。结论 HBO可缩短中、重度 HIE患儿疗程 ;早期治疗可提高治愈率 ,减少后遗症 ;晚期治疗 ,近期疗效明显 ,但重症不能改善预后。

Objective To study the efficacy of hyperbaric oxygenation (HBO) in curing the newborn with HIE.Methods One hundred and forty cases of neonates with HIE (hypoxic-ischemic encephalopathy) were divided randomly into HBO group (n=78) and control group (n=62).The survival cases were followed up for 1～4 years.The IQ was estimated by using mental development indexes (MDI).Physical and mental development,vision and hearing were also examined.Other concurrent therapies were the same in the two groups.Results ①The nervous system recovery time in moderate and severe cases were (5.4±2.2)days in HBO group and (8.6±3.5)days in control group (t=5.78,P<0.01).Those mild cases showed no differences between the two groups.②HBO group had 8 sequela cases and one dead case,but control group had 10 sequela and 3 dead.③The early treatment of HIE gave an unfavorable prognosis rate only 7.8% in HBO group,but gave 23.6% in control group (χ 2=3.9,P<0.05).The late treatment gave no differences between the two groups.Conclusion HBO has a fairly shorter course in treating the moderate～severe HIE;its early use can improve the cure rate,reduce sequela;its late use also gives an immediate effect,but severe cases would not expect a favorable prognosis.