脑蛋白水解物及单唾液酸四已糖神经节苷脂联合治疗新生儿缺血缺氧性脑病65例.docVIP

脑蛋白水解物及单唾液酸四已糖神经节苷脂联合治疗新生儿缺血缺氧性脑病65例摘 要 目的：探讨单用脑蛋白水解物与联合使用单唾液酸四已糖神经节苷脂，治疗新生儿缺血缺氧性脑病的临床疗效。方法：随机分成两组。治疗组(联合使用脑蛋白水解物与单唾液酸四已糖神经节苷脂n=35)；对照组(脑蛋白水解物治疗组n=30)。两组病人均在对症支持处理的基础上进行，观察比较两组患儿神经系统症状体征的恢复时间，HIE临床，NBNA评分。结果：治疗组新生儿症状体征恢复时间明显较对照组缩短，P0.01，差异有显著性，生后7～8天，10～14天NBNA评分治疗组分值高于对照组，P0.05，差异有显著意义。结论：联合使用脑蛋白水解物与单唾液酸四已糖神经节苷脂治疗HIE，较单用脑蛋白水解物能显著缓解症状体征，缩短病程，减轻脑损伤，提高治愈率。 关键词 新生儿缺血缺氧性脑病 脑蛋白水解物 单唾液酸四已糖神经节苷脂 doi：10.3969/j.issn.1007-614x.2009.03.056 Abstract Objective：To investigate the curative effect of GM-Ⅰcombined with cerebroprotein hydrolysate on hypoxic-ischemic encephalopathy(HIE) in neonate .Methods：65 cases of neonatal hypoxic-ischemic encephalopathy were divided randomly into observation group(n=35) and control group(n=30).In addition to individualized supportive treatment，patients in control group were treated with cerebroprotein hydrolysate，patients in observation group were treated with ganglioside GM-Ⅰcombined with cerebroprotein hydrolysate.The duration of recovery and the changes of neonatal behavior neurological assessment(NBNA) in the two groups were compared.Results：The recovery time of observation group was obviously shorter than that of control group with a singnificant difference(P0.01)； Meanwhile postnatal NBNA at 7and at 14 in observation group were obviously higher than those of control group with a singnificant difference (P0.05).Conclusion：Combination Ganglioside GM-Ⅰ with cerebrprotein hydyolysate therapy can improve clinic curative effect，lower duration of recovery，and reduce incidence of disability in neonates with HIE. 资料和方法 一般资料：我科收治的65例中、重度HIE患儿，均为足月新生儿。诊断依据和临床分度根据1996年10月杭州全国新生儿会议标准[1]，患儿入院后依据其家庭经济状况与家长意愿分成两组：单用脑蛋白水解物组30例，其中死亡1例，中度HIE 24例，重度HIE 5例。联用脑蛋白水解物与单唾液酸四己糖神经节苷脂治疗组35例，其中中度HIE 30例，重度HIE 5例。两组在性别、胎龄、出生体重、年龄和HIE分度等方面差异无显著性。 方法：两组患儿入院后均维持良好通气、换气功能，使血气和PH保持在正常范围，维持好各脏器灌注和血糖在正常高值，控制惊厥，降颅压，消除脑干症状等。在此基础上，对照组给予脑蛋白水解物治疗(生后2～3天)，疗程为10天；治疗组除使用脑蛋白水解物外，生后1～2天给予单唾液酸四已糖神经苷脂钠，40mg/次，静滴1次/日，疗程为10天。 疗效评价：每天观察患儿生命体征、意识、肌张力、前囟张力、原始反射、惊厥以及脑干症状，生后