65例危重新生儿亚低温转运单中心研究

Single center study of mild hypothermia transport in 65 critical newborns

目的评估厦门市儿童医院新生儿重症监护室(neonatal intensive care unit,NICU)转运过程实施新生儿亚低温治疗,缩短亚低温治疗窗的成效。方法回顾性分析2015年6月至2019年6月我院NICU实施亚低温治疗病例,将纳入的65例患儿分为三组,其中对照组20例,在转运入院评估后实施亚低温;主动亚低温组18例,在转运时采用亚低温治疗仪实施亚低温治疗;被动亚低温组27例,入院前采用关掉暖箱电源,敞开包被方式实施亚低温治疗。分析对比三组患儿出生和入院时的体征及实验室指标,观察三组患儿亚低温治疗后患儿头颅MRI、振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)和新生儿行为神经测定(neonatal behavioral neurological assessment,NBNA)结果。结果主动亚低温组有3例出现体温过低(<33℃),被动亚低温组有7例入院时体温高于目标温度(>34℃)。主动亚低温组达到目标温度的时间、体温波动值和PaCO2低于被动亚低温组和对照组,被动亚低温组开始的平均时间为(1.0±0.2)h,低于主动亚低温组(2.2±0.6)h和对照组(3.2±0.8)h(P<0.05)。治疗后主动、被动亚低温组头颅MRI及aEEG异常发生率低于对照组(头颅MRI 65%,aEEG 80%),NBNA评分高于对照组(P<0.05)。转运途中三组均未发生心跳呼吸骤停、肺出血等并发症。结论尽早实施亚低温有助于HIE的治疗和预后,具备亚低温治疗和神经系统评估的转运队伍有助于转运中亚低温的顺利实施。推荐在转运过程实施主动亚低温,降温效果明显,体温波动小。

Objective To evaluate the effect of neonatal mild hypothermia therapy during NICU transport in our hospital and how it shorten the window of mild hypothermia treatment.Methods A retrospective analysis of mild hypothermia therapy was performed in NICU in our hospital from June 2015 to June 2019.Sixty-five patients were divided into 3 groups.Twenty newborns in the control group were treated with mild hypothermia after admission evaluation.In the active mild hypothermia group,eighteen patients were treated with mild hypothermia therapeutic apparatus in the process of transport.In the passive mild hypothermia group,twenty-seven cases were treated by closing the incubator and opening the quilt before transport.The physical signs and laboratory indexes at birth and admission of the three groups were analyzed and compared,and the effects of skull MRI,amplitude integrated electroencephalogram(aEEG)and neonatal behavioral neurological test(NBNA)after mild hypothermia treatment were observed.Results There were 3 cases of hypothermia in the active mild hypothermia group(<33℃),and 7 cases in the passive mild hypothermia group were still higher than the target temperature(>34℃).The time to reach the target temperature,body temperature fluctuation and PaCO2 in the active mild hypothermia group were shorter than those in the passive transport group and control group,and the average starting time in the passive mild hypothermia was shorter than that in the active mild hypothermia group(2.2±0.6)h and the control group(3.2±0.8)h(P<0.05).After treatment,the incidence of abnormal MRI and aEEG in the active and passive mild hypothermia group was lower than that in the control group(abnormal MRI65%、aEEG80%),and the NBNA score was higher than that in the control group.During the transport,there were no complications such as cardiorespiratory arrest and pulmonary hemorrhage in the three groups.Conclusion The early implementation of mild hypothermia is helpful to the treatment and prognosis of HIE,and the transport team with mild hypothermia therapy and nervous system evaluation is helpful to the mild hypothermia transport.It is recommended to perform active mild hypothermia in the process of transport,with obvious cooling effect and slight body temperature fluctuation.