小儿推拿联合神经生长因子对小儿急性缺血缺氧性脑病神经功能的影响

Effect of pediatric Tuina combined with nerve growth factor therapy on neural function of children with acute ischemic hypoxic encephalopathy

目的探讨小儿推拿联合神经生长因子对小儿急性缺血缺氧性脑病(hypoxie-ischemic encephalopathy,HIS)神经功能的影响。方法将符合入选标准的2017年2月-2019年10月华中科技大学同济医学院附属湖北妇幼保健院96例HIS患儿,采用随机数字表法分为2组,每组48例。对照组在常规治疗基础上加用神经生长因子,观察组在对照组基础上予以小儿推拿治疗。采用新生儿行为神经评分(Neonatal Behavioral Neurological Assessment,NBNA)评估患儿的神经行为,采用智能发育指数(Mental Development Index,MDI)及精神运动发育指数(Psychomotor Development Index,PDI)评估患儿智能发育及运动协调和技巧行为能力,采用脑电图仪检测患儿脑电图棘波波幅,采用电解式组织血流计检测患儿局部脑血流量,采用ELISA法检测血清髓鞘碱性蛋白(myelin basic protein,MBP)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)及VEGF,评价临床疗效。结果观察组总有效率为95.8%(46/48)、对照组为81.3%(39/48),2组比较差异有统计学意义(χ^(2)=5.03,P=0.025)。观察组出生后28 d NBNA评分(t=-2.55,P=0.012)及出生后3个月MDI、PDI评分均高于对照组(t值分别为-3.43、-2.65,P值均<0.01)。治疗后,观察组脑电图棘波波幅[(35.02±4.16)mV比(46.92±5.81)mV,t=11.54]低于对照组(P<0.01);脑血流量[(179.36±22.25)ml/(100 g·min)比(158.30±14.92)ml/(100 g·min),t=-5.45]高于对照组(P<0.01)。观察组治疗后血清MBP、NSE、VEGF水平均低于对照组(t值分别为3.29、4.07、8.17,P值均<0.01)。结论小儿推拿联合神经生长因子可有效改善HIS患儿神经行为及智能指标,增加脑血流量,降低脑电图棘波波幅及MBP、NSE及VEGF水平,提高疗效。

Objective To explore the effect of pediatric massage combined with nerve growth factor treatment on the neurological function of children with acute ischemic hypoxic encephalopathy(HIS).Methods A total of 96 children with HIS who were treated in Hubei Maternal and Child Health Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 2017 to October 2019 were selected for the study.The children were divided into 2 groups using a random number table method,with 48 cases in each group.The control group was treated with nerve growth factor on the basis of conventional treatment,and the observation group was treated with pediatric massage on the basis of the control group.The clinical efficacy,neurobehavior,intelligence index,EEG index,cerebral blood flow and hematology index were compared between the two groups.Results The total effective rate of the observation group was 95.84%,which was higher than 81.25%of the control group,and the difference between the two groups was statistically significant(χ2=5.03,P=0.025).The 28-day NBNA score(t=-2.55,P=0.012)and three-month MDI and PDI of the observation group were significantly higher than those of the control group(t values were-3.43,-2.65,all Ps<0.01).After treatment,the EEG spike wave amplitude of the two groups of children decreased significantly,and the decrease was greater in the observation group[(35.02±4.16)mV vs.(46.92±5.81)mV,t=11.54].After treatment,the cerebral blood flow of the two groups of children increased significantly,and the increase was more significant in the observation group[(179.36±22.25)ml/(100 g•min)vs.(158.30±14.92)ml/(100 g•min),t=-5.45].After treatment,the levels of MBP,NSE and VEGF in the two groups of children decreased significantly,but the decrease in the observation group was greater(t values were 3.29,4.07,8.17,all Ps<0.01).Conclusion Pediatric massage combined with nerve growth factor alone can improve the curative effect of children with HIS,improve neurobehavioral and intelligent indicators,increase cerebral blood flow,and reduce EEG spike wave amplitude and MBP,NSE and VEGF levels.