维生素E联合神经节苷脂治疗新生儿中重度缺氧缺血性脑病的一年期内疗效

One Year Neurologic Prognostic Outcome of Vitamin E Combined with Monosialotetrahexosyl Ganglioside in the Treatment of Median-severe Neonatal Hypoxic-ischemic Encephalopathy

目的:观察接受维生素E联合外源性单唾液酸四己糖神经节苷脂(Monosialotetrahexosyl Ganglioside,GM)治疗新生儿中重度缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的一年神经预后,为临床治疗提供指导。方法:选择2017年1月-2018年1月在本院接受治疗的70例中重度新生儿HIE为研究对象,根据随机数字表法将其分为观察组(n=35)和对照组(n=35)。所有新生儿均采取低温和常规治疗,对照组在此基础上接受GM治疗,观察组接受维生素E联合GM治疗。比较两组短期临床疗效和长期神经症状改善情况。结果:观察组新生儿的优比例和总有效率均显著高于对照组(P<0.05)。根据Bailey量表总分的评估值,观察组正常儿童的比例为41.2%(14/34),显著高于对照组的18.2%(6/33)(P<0.05)。观察组新生儿治疗早期的意识、肌肉张力、原始反射和颅内压恢复时间均短于对照组(P<0.05)。两组治疗7、14、28 d的NBNA评分均明显高于治疗前,且随时间变化显著增加(P<0.05)。观察组治疗7、14、28 d后的NBNA评分均高于对照组(P<0.05)。随访结果显示,观察组治疗后3、6、12个月MDI、PDI、DQ评分均明显高于对照组(P<0.05)。结论:维生素E联合GM治疗中重度HIE患儿,对改善短期临床疗效和长期神经症状提供了额外的益处。

Objective:To observe the one year neurologic prognostic outcome of of Vitamin E combined with Monosialotetrahexosyl Ganglioside (GM) in the treatment of median-severe neonatal hypoxic-ischemic encephalopathy to provide new guidelines for clinical treatment.Method:Seventy neonates with median-severe HIE who treated in our hospital from January 2017 to January 2018 were selected as the subjects.According to the random number table method,the neonates were divided into the observation group (n=35) and the control group (n=35).All newborns underwent hypothermia and conventional treatment for their conditions.On this basis,the control group received GM treatment,while the observation group received vitamin E combined with GM treatment.The short-term clinical efficacy and long-term improvement of neurological symptoms of two groups were compared.Result:The superiority ratio and total effective rate of newborns in the observation group were significantly higher than those in the control group (P<0.05).According to the total score of Bailey scale,the proportion of normal children in the observation group was 41.2% (14/34),which was significantly higher than 18.2% (6/33) in the control group (P<0.05).The early recovery time of consciousness,muscle tension,primitive reflex and intracranial pressure in the observation group were shorter than those in the control group (P<0.05).After 7,14 and 28 d of treatment,the NBNA scores of two groups were significantly higher than those before treatment,and the score increased with time (P<0.05).After 7,14 and 28 d of treatment,the NBNA scores of the observation group were higher than those of the control group (P<0.05).3,6 and 12 months after treatment,the follow-up results showed that the scores of MDI,PDI and DQ in the observation group were significantly higher than those in the control group (P<0.05).Conclusion:The treatment of Vitamin E combined with GM on newborns with median-severe severe HIE has some efficacy in improving short-term clinical effects and long-term neurological symptoms.