亚低温治疗前主动降温控制对新生儿缺氧缺血性脑病预后分析

Prognostic analysis of neonatal hypoxic-ischemic encephalopathy by active cooling control before mild hypothermia treatment

目的分析新生儿中重度缺氧缺血性脑病(HIE)在复苏后到实施亚低温治疗阶段体温对预后的影响,为临床在HIE实施亚低温治疗前准备工作提供科学依据。方法选取2016年1月至2018年12月南宁市第八人民医院新生儿科收治的窒息并发中重度HIE且进行亚低温治疗的新生儿进行前瞻性研究,简单抽样法抽取60例为研究对象,随机分为研究组(复苏后亚低温治疗前主动降温)和对照组(亚低温治疗前常规复温),最后征集到研究组32例,对照组28例,比较两组疗效和远期预后。结果亚低温治疗后研究组aEEG图形评分更高,新生儿神经行为评分(NBNA)得分更高,氧化应激反应改善程度更优,研究组意识恢复、吸吮动作、肌张力及原始反射恢复时间短于对照组,后遗症发生率低于对照组,差异有统计学意义(P<0.05)。结论窒息复苏后尽快主动降低体温为亚低温治疗做准备,可提高aEEG得分,改善预后,减少后遗症发生。

Objective To analyze the impact of body temperature on prognosis of neonates with moderate and severe hypoxic-ischemic encephalopathy(HIE)from resuscitation to mild hypothermia treatment,and to provide scientific basis for clinical preparation before mild hypothermia treatment for HIE.Methods Neonates with asphyxia complicated with moderate and severe HIE and undergoing mild hypothermia treatment admitted to department of neonatology,the eighth people’s hospital of Nanning from January 2016 to December 2018 was investigated prospectively.A total of 60 cases were selected and randomly divided into the study group(n=32,with active cooling before mild hypothermia after resuscitation)and the control group(n=28,with conventional rewarming before mild hypothermia)according to the simple sampling method in the end.And the therapeutic efficacy and long-term prognosis of the two groups were compared.Results After mild hypothermia treatment,the aEEG graphics score and neonatal behavioral neurological assessment(NBNA)score in the study group were higher,and the improvement of oxidative stress reaction was superior.The recovery time of consciousness,sucking action,muscle tension and primitive reflex in the study group was shorter than that in the control group,and the incidence of sequelae was lower than that in the control group,with statistically significant differences(P<0.05).Conclusion Taking the initiative to lower body temperature as soon as possible after resuscitation from asphyxia can raise aEEG score,improve prognosis and reduce incidence of sequelae.