不同亚低温疗法治疗偏远山区新生儿缺氧缺血性脑病的对比研究

COMPARATIVE STUDY OF DIFFERENT MILD HYPOTHERMIA THERAPIES IN TREATMENT OF NEONATAL HYPOXIC ISCHEMIC ENCEPHALOPATHY IN REMOTE MOUNTAINOUS AREAS

目的 探讨选择性头部亚低温和全身亚低温疗法治疗新生儿缺血缺氧性脑病的疗效及安全性。方法 选择缺氧缺血性脑损伤新生儿儿65例,随机分为头部亚低温组24例、全身亚低温组20例和常规治疗组21例。三组均给予常规维持治疗,头部亚低温组采用冰帽系统实施亚低温治疗,全身亚低温组采用冰毯系统实施亚低温治疗。比较三组患儿治疗后0、24、48、72 h振幅整合脑电图变化,治疗后7 d、14 d、28 dNBNA评分及治疗后不良反应发生率。结果 治疗后24 h、48 h、72 h三组患儿振幅整合脑电图最高电压、最低电压均高于治疗前,且亚低温组(A组、B组)高于常规组(C组),差异有统计学意义(P<0.05),亚低温组A组、B组比较差异均无统计学意义(P>0.05);三组患儿在治疗后7d亚低温组(A组、B组)NBNA评分与常规组(C组)比较差异无统计学意义(P>0.05);治疗后14d和28d的NBNA评分亚低温组(A组、B组)明显高于常规组(C组),差异有统计学意义(P<0.05);治疗后7d、14d、28d亚低温组A组、B组比较差异均无统计学意义(P>0.05);治疗后选择性头部亚低温治疗组及全身亚低温治疗组中仅各出现1例轻度窦性心动过缓。结论 选择性头部亚低温和全身亚低温治疗均能有效保护患儿脑功能,降低中、重度HIE患儿伤残风险,改善神经运动发育结局。

Objective To investigate the efficacy and safety of selective head mild hypothermia and systemic mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy.Methods Sixty-five newborns with hypoxic-ischemic brain injury were randomly divided into 24 cases of head mild hypothermia group, 20 cases of systemic mild hypothermia group and 21 cases of routine treatment group.The three groups were given routine maintenance treatment.The head mild hypothermia group was treated with ice cap system, and the whole-body mild hypothermia group was treated with ice blanket system.The amplitude integrated EEG changes at 0,24,48 and 72 hours after treatment, NBNA scores at 7,14 and 28 days after treatment and the incidence of adverse reactions were compared among the three groups.Results The maximum voltage and minimum voltage of amplitude integrated EEG in the three groups were higher than those before treatment at 24 h, 48 h and 72 h after treatment, and the mild hypothermia group(group A and group B) was higher than that in the routine group(Group C),the difference was statistically significant(P<0.05),and there was no statistically significant difference between group A and group B in the mild hypothermia group(P>0.05);there was no significant difference in NBNA score between mild hypothermia group(group A,group B) and routine group(Group C) 7 days after treatment(P>0.05);the NBNA score of mild hypothermia group(group A and group B) was significantly higher than that of routine group(Group C) at 14 and 28 days after treatment(P<0.05);there was no significant difference between group A and group B in mild hypothermia group at 7,14 and 28 days after treatment(P>0.05);after treatment, only 1 case of mild sinus bradycardia occurred in the selective head mild hypothermia treatment group and the systemic mild hypothermia treatment group respectively.Conclusion The selective head mild hypothermia and systemic mild hypothermia can effectively protect children’s brain function, reduce the risk of disability in children with moderate and severe HIE,andimprove the outcome of neuromotor development.