亚低温治疗新生儿缺氧缺血性脑病研究进展

Research progress of mild hypothermia in treatment of neonatal hypoxic-ischemic encephalopathy

新生儿缺氧缺血性脑病（HIE）是导致新生儿死亡的重要原因，存活者往往留有不同程度的脑损害及神经系统发育障碍。HIE在发达国家发病率大约为（1～2）／1000，发展中国家的发病率更高，在存活的新生儿中可达75／1000。我国高原出生的新生儿，HIE的发病率及病死率居全国前列。亚低温治疗是人类目前已知的唯一安全且有效的神经保护治疗方法，国内外多个多中心随机试验均报道亚低温治疗能够安全有效地保护HIE患儿的大脑功能。最初的试验结果发表距今已有10余年，在发达国家亚低温已被列为HIE的常规治疗方法，而在我国远不及此，特别是在高原地区。本文主要阐述HIE的发病机制及高原地区的发病特点，亚低温治疗HIE的机制及其近10年在国际特别是国内的应用及存在的问题。

Neonatal hypoxic ischemic encephalopathy（HIE） remains a major cause of neonatal morbidity and mortality. Survivors have different degrees of brain damage and ncurodevelopmental impairment. The incidence of HIE in the developed countries is about （1-2）/1 000 in newborns; it can be up to 75/1 000, much higher in the developing countries than that in developed countries. The incidence and mortality of HIE at high altitude areas are the highest in China. Mild hypothermia has been known as the only safe and effective treatment to reduce brain injury in children with HIE in numerous randomized trials in many countries including China; the initial results were published more than 10 years ago. Since then, mild hypothermia has been used as a routine treatment for HIE in the developed countries; but this is not the case in China, particularly at high altitude areas. This article described pathogenesis and clinical features of HIE and mechanisms of mild hypothermia therapy, with focus on problems of mild hypothermia application in China in the past 10 years.