亚低温治疗新生儿缺氧缺血性脑病临床疗效观察.docVIP

亚低温治疗新生儿缺氧缺血性脑病临床疗效观察 　　【摘要】 目的 探讨应用选择性头部亚低温治疗新生儿缺氧缺血性脑病（HIE）的临床效果。方法46例HIE足月儿为临床研究对象， 随机将患儿分为亚低温治疗组及对照组， 每组23例。对两组患儿采取维持血压、血氧饱和度、灌注及血糖等内环境稳定， 通气、止惊、降低颅压及消除脑干症状等措施治疗， 治疗组患儿在出生6 h内加用选择性头部亚低温进行治疗， 72 h内对患儿进行脑部复温。观察两组 HIE 治疗前、治疗6、24、48、72 h神经症状发生率、呼吸、心率、血压、血氧饱和度及生化变化。结果治疗组24、48、72 h心率较治疗前下降（P0.05）， 治疗后血气分析变化差异有统计学意义（P0.05）。治疗后， 两组神经系统症状及体征变化差异有统计学意义（P0.05）。结论 对HIE新生儿应用选择性头部亚低温治疗是安全有效的， 对HIE近期效果显著。 　　【关键词】 缺氧缺血性脑病；新生儿；亚低温 　　【Abstract】 Objective To investigate the clinical effect of selective head mild hypothermia in the treatment of neonatal hypoxic ischemic encephalopathy （HIE）. Methods A total of 46 term infants with HIE as study subjects were randomly divided into mild hypothermia treatment group and control group， and each group contained 23 cases. Both groups received maintenance of blood pressure， oxyhemoglobin saturation， perfusion， and blood glucose with the treatment of ventilation， relieving fright， reducing cranial pressure and eliminating brainstem symptoms. The treatment group received additional selective head mild hypothermia within 6 h after birth， and rewarm within 72 h. The change of incidence neurologic symptoms， breathing， heart rate， blood pressure， oxyhemoglobin saturation， and biochemical changes of the two group were compared before HIE treatment， and in 6 h， 24 h， 48 h， and 72 h of the treatment. Results Heart rates in 24 h， 48 h， and 72 h in the treatment group were all decreased， compared with that before treatment （P0.05）. After treatment， there were significant differences of the change of blood gas analysis （P0.05）. The changes of neurological symptoms and physical signs in the two groups were obvious after treatment， and the difference had statistical significance （P0.05）. Conclusion Application of selective head mild hypothermia for newborn with HIE is safe and effective， and it has significant short-term effect on HIE. 　　【Key words】 Hypoxic ischemic encephalopathy； Newborn； Mild hypothermia 　　围生期窒息所致缺氧缺血性脑病（hypoxic ischemic ence