摘要
目的探讨3种不同的亚低温疗法治疗新生儿缺血缺氧性脑病(hypoxic-ischemic encephalopathy,HIE)的临床疗效及安全性。方法选取2010年12月至2014年11月徐州市儿童医院新生儿科收治的HIE共62例,按随机数字表法分为选择性头部降温组(A组)19例,全身降温组(B组)21例,头部降温联合轻度全身降温组(C组)22例。三组入院后均给予儿科常规维持治疗,在病儿出生6～12 h内,给予三组病儿不同的降温治疗。近期疗效测定采用新生儿神经行为测定评分系统(NBNA)分别于生后1周、2周、3周进行测定;远期疗效测定采用神经发育评分测试分别于生后3个月、6个月、12个月、18个月进行评估;将18个月时死亡、脑瘫、反应迟钝的例数作为评价预后不良的指标。结果三组病儿一般资料比较差异无统计学意义(P>0.05);不同测定时相之间NBNA评分差异有统计学意义(F=822.54,P=0.00),测定时相与治疗方法间有交互作用(F=10.19,P=0.00);不同处理组间NBNA评分差异有统计学意义(F=8.75,P=0.00),A、C组(t=-6.37,P=0.00)和B、C组(t=-5.62,P=0.00)NBNA评分差异有统计学意义,C组NBNA评分最高(A,B,C组NBNA评分分别为35.50分,35.50分,36.68分)。不同测定时相之间神经发育评分差异有统计学意义(F=323.28,P=0.00),测定时相与治疗方法间有交互作用(F=3.22,P=0.02);不同处理组间神经发育评分差异有统计学意义(F=6.01,P=0.00),通过两两比较同样发现A、C组(t=-2.84,P=0.02)和B、C组(t=-2.53,P=0.01)差异有统计学意义,因此可认为C组病儿的远期神经发育评分最高(A,B,C组远期神经发育评分分别为91.69分,91.40分,94.17分)。18个月随访时,A组死亡1例,为意外死亡;三组均有1例失访;A、C组未发现脑瘫及反应迟钝病儿,B组发现脑瘫病儿1例。结论运用头部降温联合轻度全身降温法,近期、远期疗效均较选择性头部降温和全身降温两种方法有所改观,值得临床推广。
Objective To investigate the clinical efficacy and safety of three different hypothermia therapies for neonatal hypoxic-ischemic encephalopathy(HIE).Methods Sixty-two neonates with HIE admitted to Department of Neonatal Intensive Care Unit of Xuzhou Children s Hospital from December 2010 to November 2014 were randomly assigned into group A(head hypothermia group,n=19),group B(systemic hypothermia group,n=21)and group C(head hypothermia combined with mild systemic hypothermia group,n=22)according to random number table method.After admission to hospital,the neonates in three groups underwent routine maintenance treatmentand respective hypothermia therapies 6-12 h after birth.Neonatal behavioral neurological assessment(NBNA)was used to measure the short-term efficacy at 1 week,2 weeks and 3 weeks after birth.The neurodevelopmental assessment was used to measure the long-term efficacy at 3 months,6 months,12 months and 18 months after birth.The numbers of death,cerebral palsy,and retarded response of neonates at 18 months was used as indicators for the evaluation of poor prognosis.Results There were no statistical differences in general information among the three groups(P>0.05).There was significant difference in the NBNA score between different time points(F=822.54,P=0.00),and there was an interaction between the measurement phase and the treatment method(F=10.19,P=0.00).There was significant difference in NBNA score between different treatment groups(F=8.75,P=0.00).There were significant differences in NBNA scores between group A and group C(t=-6.37,P=0.00)and between group B and group C(t=-5.62,P=0.00).Group C had the highest NBNA score(The NBNA scores of the groups A,B and C were 35.50,35.50 and 36.68,respectively).There was significant difference in neurodevelopmental score between different time points(F=323.28,P=0.00),and there was an interaction between the measurement phase and the treatment method(F=3.22,P=0.02).There was significant difference in neurodevelopmental score between different treatment groups(F=6.01,P=0.00).There were significant differences in neurodevelopmental score between group A and group C(t=-2.84,P=0.02)and between group B and group C(t=-2.53,P=0.01).Therefore,group C had the highest long-term neurodevelopmental score(The neurodevelopmental scores of the groups A,B and C were 91.69,91.40,and 94.17,respectively).During the 18-month follow-up,1 patient died in group A,which was an accidental death.One case was lost to follow-up in respective three groups.No children with cerebral palsy or retarded response were found in groups A and C,and 1 child with cerebral palsy was found in group B.The difference in the incidence of poor prognosis among the three groups was not statistically significant(P>0.05).Conclusion The combined use of head hypothermia and mild systemic hypothermia can achieve better short-term and long-term efficacy than the selective head hypothermia and systemic hypothermia,which is worthy of clinical application.
作者
尚培薇
边兆敏
孙逊
李振光
魏玉珍
SHANG Peiwei;BIAN Zhaomin;SUN Xun;LI Zhenguang;WEI Yuzhen(Department of Neonatal Intensive Care Unit,Xuzhou Children's Hospital,Xuzhou,Jiangsu 221000,China)
出处
《安徽医药》
CAS
2019年第6期1148-1151,共4页
Anhui Medical and Pharmaceutical Journal
关键词
新生儿
缺血缺氧性脑病
亚低温治疗
临床疗效
Neonatal
Hypoxic ischemic encephalopathy
Mild hypothermia therapy
Clinical efficacy
