阿莫西林钠克拉维酸钾联合头部亚低温治疗新生儿缺血缺氧性脑病伴肺部感染的临床观察

Clinical Observation of Amoxicillin Sodium and Clavulanate Potassium Combined with Cranial Mild-moderate Hypothermia in the Treatment of Neonatal Hypoxic-ischemic Encephalopathy Complicating with Pulmonary Infection

目的：探讨阿莫西林钠克拉维酸钾联合头部亚低温治疗新生儿缺血缺氧性脑病（HIE）伴肺部感染的临床疗效及安全性。方法：将80例HIE伴肺部感染的患儿按随机数字表法分为观察组（42例）和对照组（38例）。对照组患儿在正常体温下采取降颅压、纠正酸碱平衡、营养支持、抗惊厥等常规治疗措施,并在此基础上应用阿莫西林钠克拉维酸钾30 mg/kg静脉滴注,tid,每次滴注时间不短于30 min,持续用药3 d。观察组患儿在对照组治疗基础上加以实施头部亚低温治疗：在患儿头部放置降温帽,温度设置为10℃,将鼻咽部的温度控制在34℃、肛温控制在33~37℃;体温降幅1℃/h;当体温降至34.5℃后持续治疗3 d,然后取走降温帽,让体温自然恢复。观察两组患儿的HIE和肺部感染治疗效果,记录两组患儿出生后1、2、4周的新生儿神经行为测定（NBNA）评分,并观察不良反应发生情况。结果：观察组患儿的HIE治疗总有效率（95.24%vs.78.95%）及肺部感染治愈率（52.38%vs.26.32%）、总有效率（85.71%vs.65.79%）均显著高于对照组,差异均有统计学意义（P〈0.05）。两组患儿出生后1周的NBNA评分比较,差异无统计学意义（P〉0.05）;出生后2、4周的NBNA评分均较出生后1周明显提高,且观察组显著高于对照组,差异均有统计学意义（P〈0.05）。两组患儿的不良反应发生率比较,差异无统计学意义（P〉0.05）。结论：阿莫西林钠克拉维酸钾联合头部亚低温治疗HIE伴肺部感染的疗效较好,能明显改善患儿预后,且安全性较好。

OBJECTIVE： To investigate the clinical efficacy and safety of amoxicillin sodium and clavulanate potassium com- bined with cranial mild-moderate hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy （HIE） complicating with pulmonary infection. METHODS： 80 children with HIE complicating with pulmonary infection were randomly divided into ob- servation group （42 cases） and control group （38 cases）. Control group received routine treatment under normal body temperature as lowering intracranial pressure, correcting acid-base balance, giving nutritional support and anticonvulsive treatment, and then was given amoxicillin sodium and clavulanate potassium 30 mg/kg intravenously, tid, more than 30 min each time, for consecutive 3 d. On the basis of control group, observation group was additionally given cranial mild-moderate hypothermia therapy： wearing cooling cap, at 10 % ; keeping pharynx nasalis temperature at 34 % ; keeping rectal temperature at 33-37 % ; decreasing at rate of 1 ℃/h. They continued treatment for 3 d till body temperature decreased to 34.5 % ; and then cooling cap was taken off to recover normal body temperature. Therapeutic efficacy of HIE and pulmonary infection were observed in 2 groups. NBNA score of 2 groups were recorded 1st, 2nd and 4th week after birth, and the occurrence of ADR was observed. RESULTS： Total effective rate of HIE therapy （95.24% vs. 78.95% ） , cure rate of pulmonary infection （52.38% vs. 26.32% ） and total effective rate （85.71% vs. 65.79% ） in observation group were significantly higher than control group, with statistical significance （P〈0.05）. There was no statistical significance in NBNA score between 2 groups 1st week after birth （P〉0.05）. Compared to 1st week after birth, NBNA score were significantly improved 2nd and 4th week after birth, and the observation group were significantly higher than the control group, with statistical significance （P〈0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P〉 0.05）. CONCLUSIONS： Amoxicillin sodium and clavulanate potassium combined with cranial mild-moderate hypothermia is effec- tive for HIE complicating with pulmonary infection, and can effectively improve the prognosis of children with good safety.