苯巴比妥预防新生儿重度窒息后脑损伤的临床观察

Clinical observation of phenobarbital in the prevention of neonatal brain damage after severe asphyxia

目的:探讨苯巴比妥预防新生儿重度窒息后脑损伤的临床效果。方法:2013年1月-2014年7月收治重度窒息新生儿60例,随机分成观察组和对照组,各30例。所有患者均给予一般常规治疗,对照组给予纳洛酮0.05 mg/kg静脉滴注,抽搐时临时给予苯巴比妥或安定。观察组在对照组的基础上于出生后6 h内给予苯巴比妥负荷量15~20mg/kg,最大用量30 mg/kg,连用3~5 d。结果:观察组惊厥、激惹、肌张力异常、兴奋抑制症状例数明显少于对照组,而且恢复时间明显缩短,与对照组比较差异有统计学意义(P<0.05)。观察组发生ICH 1例,发生HIE 9例,正常20例,死亡1例,死亡率3.3%;对照组发生ICH 9例,发生HIE 17例,正常4例,死亡5例,死亡率16.7%。两组比较差异有统计学意义(P<0.05)。结论:早期应用苯巴比妥能够有效降低新生儿重度窒息后脑损伤程度,大大降低新生儿死亡率,值得临床推广。

Objective:To explore the clinical effect of phenobarbital in the prevention of neonatal brain damage after severe asphyxia.Methods:60 cases of severe asphyxia neonates were selected from January 2013 to July 2014.They were randomly divided into the observation group and the control group with 30 cases in each group.All the patients were given routine therapy.The control group was given naloxone intravenous infusion of 0.05 mg/kg,when convulsions,patients were provided with phenobarbital or diazepam temporarily.The observation group was given a loading dose of phenobarbital for 15 to 20 mg/kg after birth within 6 hours on the basis of the control group,the maximum dosage was 30 mg/kg,for 3 to 5 days.Results:In the observation group,seizures,irritability,muscle tension,excitement and inhibition symptoms case number were significantly lower than the control group,and the recovery time was shortened obviously,compared with the control group,the difference was statistically significant(P<0.05).In the observation group,1 case had ICH,9 cases had HIE,20 cases were normal,1 case was death,the mortality rate was 3.3%,in the control group,9 cases had ICH,17 cases had HIE,4 cases were normal,5 cases died,the mortality rate was 16.7%.Compared the two groups,the difference was statistically significant(P<0.05).Conclusion:Early application of phenobarbital can effectively reduce the neonatal brain injury degree of severe asphyxia,greatly reduce the neonatal mortality rate,and it is worth the clinical promotion.