神经节苷酯辅助亚低温治疗早产儿缺氧缺血性脑病的疗效观察

Curative Effect of Garglioside Assisted Mild Hypothermia in the Treatment of Premature Infants with Hypoxic Ischemic Encephalopathy

目的观察神经节苷酯辅助亚低温治疗早产儿缺氧缺血性脑病的疗效。方法将73例缺氧缺血性脑病早产儿根据治疗方案分为两组:对照组(43例)给予吸氧等常规治疗并于出生6 h内给予头部亚低温;观察组(30例)在对照组基础上给予神经节苷酯静脉注射,20 mg/次,1次/d。治疗3个疗程后,观察治疗总有效率、病死率、症状(意识、反射、肌张力、惊厥)恢复或者改善时间。比较两组患儿治疗前,治疗后15 d、30 d的NBNA评分。随访12个月,比较两组的随访结果。结果治疗3个疗程后,观察组的治疗总有效率为90.0%,显著高于对照组的69.8%(P=0.040)。观察组的意识恢复时间、惊厥改善时间等均显著短于对照组,差异有统计学意义(P<0.05)。治疗前,两组的NABA评分比较无显著差异(P>0.05);治疗后15 d、30 d,两组的NABA评分均改善,组内比较有显著差异(P<0.05),观察组显著高于对照组,组间比较有显著差异(P<0.05)。随访4个月,两组的PDI、MDI评分比较,差异无统计学意义(P>0.05);随访8个月、12个月,两组的PDI、MDI评分均显著改善(P<0.05),且观察组的改善程度显著优于对照组(P<0.05)。两组的病死率及不良反应发生率比较,差异无统计学意义(P>0.05)。结论神经节苷酯辅助亚低温治疗早产儿缺氧缺血性脑病有助于改善临床症状,提高治愈率,减少神经系统后遗症,且不会增加不良反应的发生,值得临床上推广应用。

Objective To observe the therapeutic effect of garglioside assisted mild hypothermia in the treatment of premature infants with hypoxic ischemic encephalopathy. Methods 73 cases of premature infants with hypoxic ischemic encephalopathy were divided into two groups according to the therapeutic regimen. 43 cases of control group received routine therapy including oxygen inhalation combined with head mild hypothermia therapy within 6 hours after born, while in addition to therapeutic methods in control group, 30 cases of observation group received garglioside for intravenous injection, 20 rag/time, 1 time/d. After 3 courses of treatment, the total effective rate, mortality rate, improvement time of symptoms （consciousness, reflex, muscle tension, convulsion） were observed. Before treatment, 15 days and 30 days after treatment, the NBNA scores of two groups were compared. Both groups were followed-up for 12 months, and the follow-up results of two groups were compared. Results After 3 courses of treatment, the total effective rate of observation group was 90.0%, significantly higher than 69.8% of control group, with statistical difference （P = 0.040）. The recovery time of consciousness and improvement time of convulsion of observation group were significantly shorter than those of control group, with statistical differences （P 〈0.05）. Before treatment, no statistical difference was found between two groups in the NABA score （P〉0.05）, while at 15 days and 30 days of treatment, both groups had significantly improved NABA score （intra-group comparison, P〈0.05）, and the observation group had higher NABA score than the control group （intergroup comparison, P 〈0.05）. At the 4th month of follow-up, no statistical difference was found between two groups in the PDI score and MDI score （P〈0.05）; while at 8th and 12th month of followed-up, both groups had significant improvements of PDI score and MDI score （intra-group comparison, P〈0.05）, and the improvements of observation group were significantly better than those of control group （intergroup comparison, P〈0.05）. No statistical difference was found between two groups in the mortality rate and incidence of adverse reactions （P〉0.05）. Conclusions Garglioside assisted mild hypothermia in the treatment of premature infants with hypoxic ischemic encephalopathy is helpful to improve the clinical symptoms, improve the curative rate, reduce the sequelae of nervous system, and will not increase the occurrence of adverse reactions, which is worthy of clinical application.