纳洛酮联合促红细胞生成素注射液治疗新生儿缺氧缺血性脑病的效果观察

Effect of Naloxone Combined with Erythropoietin Injection on Neonatal Hypoxic-ischemic Encephalopathy

目的探讨纳洛酮联合促红细胞生成素(erythropoietin,EPO)注射液治疗新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的临床效果。方法选取2014年9月～2017年9月青海红十字医院新生儿科门诊收治的216例HIE患儿作为研究对象,随机分为观察组和对照组,各108例。观察组采用纳洛酮联合EPO注射液治疗,对照组采用纳洛酮治疗。比较2组患儿临床疗效、临床症状改善时间、贝利婴幼儿发展量表评分、Gesell量表评分、血细胞计数、血清神经功能指标、血清细胞因子及后遗症发生情况。结果观察组总有效率(95.4%)显著高于对照组(85.2%)(P<0.05),且观察组中度有效率和重度有效率均显著高于对照组(P<0.05)。观察组意识恢复时间、原始反射恢复时间及肌张力恢复时间显著短于对照组(P<0.05)。2组患儿治疗后1周新生儿行为神经测定(neonatalbehavioralneurologicalassessment,NBNA)评分无统计学差异,观察组患儿治疗后2周NBNA评分显著高于对照组(P<0.05)。观察组患儿3月龄、6月龄神经发育指数和心理运动发育指数评分均显著高于对照组(P<0.05)。观察组Gesell量表大运动能区、精细运动能区、语言能区、个人社区能区、社会适应能区发育商分值均显著高于对照组(P<0.05)。治疗后,观察组血红蛋白、网织红细胞计数、血小板计数水平显著高于对照组(P<0.05)。观察组血清神经元特异性烯醇化酶、髓鞘碱性蛋白、S100钙结合蛋白水平显著低于对照组(P<0.05)。观察组血清tau、内源性激活素A、TNF-α水平显著低于对照组(P<0.05)。2组患儿后遗症发生率无统计学差异。结论纳洛酮联合EPO注射液治疗HIE的疗效显著,可有效改善患儿的神经系统功能,减少后遗症的发生率。

OBJECTIVE To investigate the clinical effect of naloxone combined with erythropoietin(EPO) injection in the treatment of neonatal hypoxic-ischemic encephalopathy(HIE). METHODS From September 2014 to September 2017, 216 children with HIE were selected as subjects in the pediatric department of Qinghai Red Cross Hospital, and randomly divided into observation group and control group, 108 cases in each group. The observation group was treated with naloxone combine EPO injection and the control group was treated with naloxone. The clinical efficacy, clinical symptom improvement time, score of Bailey infant development scale, score of Gesell scale, blood cell count, serum neurologic function, serum cytokines and sequelae incidence were compared between the two groups. RESULTS The total effective rate of the observation group(95.4%) was significantly higher than that of the control group(85.2%)(P<0.05). The moderate efficiency and severe efficiency of the observation group were significantly higher than that of the control group(P<0.05). The recovery time of consciousness, original reflex and muscle tension in the observation group were significantly shorter than those in the control group(P<0.05). The neonatal behavioral neurological assessment(NBNA) scores in the two groups was had no significant difference one week after treatment, while the scores in the observation group were significantly higher than those in the control group 2 weeks after treatment(P<0.05). The mental development index score and psychomotor development index score of the 3 months old and 6 months old children in the observation group were significantly higher than those in the control group(P<0.05). The development quotient scores of the large kinetic energy zone, the fine motor energy zone, the linguistic energy zone, the individual community energy zone and the social adaptive energy zone of the observation group in Gesell scale were significantly higher than the control group(P<0.05). After treatment, the level of hemoglobin, reticulocyte count, platelet count in the observation group were significantly higher than that in the control group(P<0.05). The serum neuron-specific enolase, myelin basic protein, S100-β level in the observation group were significantly lower than that in the control group(P<0.05). The serum tau, endogenous activin A, TNF-α level in the observation group were significantly lower than that in the control group(P<0.05). There was no significant difference in the incidence of sequelae between the two groups. CONCLUSION The efficacy of naloxone combined with EPO injection in the treatment of HIE is significant, which can effectively improve the nervous system function of children and reduce the incidence of sequelae.