选择性头部亚低温治疗新生儿缺氧缺血性脑病36例临床研究

Clinical study of selective brain hypothermia on neonatal hypoxic-ischemic brain damage (a report of 36 cases)

目的 :研究选择性头部亚低温治疗足月新生儿缺氧缺血性脑病 ( HIE)的安全性。方法 :将 32例中重度 HIE足月新生儿 ,出生体重 3.5± 0 .5 kg,5 min Apgar评分 <5分 ;生后 6h内存在脑电图异常和 (或 )临床神经系统症状和体征随机分为治疗组 1 6例和对照组1 6例。治疗组于生后 6h采用选择性头部亚低温治疗 ,维持鼻咽温度为 34.0土 0 .2℃ ,持续72 h;对照组不进行亚低温治疗。治疗前、中、后监测心率、心律、呼吸频率、呼吸暂停时间、经皮血氧饱和度、无创血压等。治疗组还检测动脉血气、电解质、血糖、肝、肾功能等。观察硬肿发生情况。结果 :亚低温治疗期间 ,治疗组患儿心率减慢 ,与对照组 2 4 h、48h、72 h比较有显著性差异 ( t值、P值分别为 1 .93,<0 .0 5 ;2 .0 4 ,<0 .0 1 ;2 .0 6,<0 .0 1 ) ,呼吸、经皮血氧饱和度、无创血压等两组比较无显著性差异 .两组均未发生硬肿症、呼吸暂停、心律失常、低血糖、低血钾、低血钠等。结论 :选择性头部亚低温治疗新生儿缺氧缺血性脑病切实可行 ,对窒息新生儿的心、肾、肝及代谢功能无不良影响 。

Objective:To study the clinical safety of selective brain hypothermia for full-term neonates with hypoxic-ischemic encephalopathy, HIE. Methods:Thirty-two medium and severe asphyxiated neonates were randomly assigned into the treatment group (n=16) and control group (n=16) with birth weight 3.5±0.5kg, Apgar<0.5, abnormal EEG and neural symptom six hours after birth. Beside the routine treatment, brain hypothermia was adopted in the treatment group and their nasopharyngeal temperature was maintained at 34.0土0.2℃ for 72 hours. The control group neonates received routine treatment. The rate and rhyme of heart, breath rate, breath break time, saturation of oxygen in blood, woundless blood pressure etc. were examined in both groups before, during and after the treatment. Electrolyte, blood sugar, and function of liver and kidney were examined only in the control group. Results:During the treatment in the control group the rate of heart was slower , t=1.93 P<0.05 (24h); t=2.04 P<2.06(48h); t=2.06 P<0.01(72h) respectively, showing significant differences while breath, saturation of oxygen in blood, woundless blood pressure showed no significant difference. No bump, breath break, arrhythmia, hypoglycemia, hypo-kalium, hypo-sodium were found in either group. Conclusion: Selective brain hypothermia on neonatal hypoxic-ischemic brain damage is feasible and secure in clinical practice without bad effects on newborn infant's heart, kidney, liver and function of metabolizability.