中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2009年
1期
27-30
,共4页
低温,人工%新生儿%缺氧缺血性脑病
低溫,人工%新生兒%缺氧缺血性腦病
저온,인공%신생인%결양결혈성뇌병
Hypothermia,induced%Neonate%Hypoxic-ischemic encephalopathy
目的 研究选择性头部亚低温(SHC)治疗新生儿缺氧缺血性脑病(HIE)的安全性及临床疗效.方法 收集新生儿重度HIE共54例,至入院96h有效病例41例,随机分为SHC组(n=21)和对照组(n=20).SHC组患儿生后6 h内开始给予SHC治疗,鼻咽部温度维持在(34.0±0.2)℃,直肠温度维持>34.5℃,持续72 h,然后自然复温;对照组患儿直肠温度维持36.0～37.5℃.两组均进行心电图、血压、经皮氧饱和度、鼻咽部温度和直肠温度监测.观察主要不良反应包括:严重心律失常、静脉血栓或出血、难以纠正的低血压.疗效观察指标包括:18个月时严重伤残发生率和病死率,智能测验运动发育指数及认知发育指数.结果 两组均未出现严重心律失常、低血压和肾功能衰竭.至生后18个月随访,共失访6例(14.6%),其中SHC组和对照组的失访率分别为14.3%(3/21)和15.0%(3/20),差异无显著性(P>0.05),实际有效病例SHC组为18例,对照组为17例.SHC组和对照组的死亡和严重伤残联合发生率分别为22.2%(4/18)、52.9%(9/17),差异有显著性(P<0.05).结论 SHC持续72 h治疗新生儿HIE是可行和安全的,可降低神经系统后遗症发生率及严重伤残率.
目的 研究選擇性頭部亞低溫(SHC)治療新生兒缺氧缺血性腦病(HIE)的安全性及臨床療效.方法 收集新生兒重度HIE共54例,至入院96h有效病例41例,隨機分為SHC組(n=21)和對照組(n=20).SHC組患兒生後6 h內開始給予SHC治療,鼻嚥部溫度維持在(34.0±0.2)℃,直腸溫度維持>34.5℃,持續72 h,然後自然複溫;對照組患兒直腸溫度維持36.0～37.5℃.兩組均進行心電圖、血壓、經皮氧飽和度、鼻嚥部溫度和直腸溫度鑑測.觀察主要不良反應包括:嚴重心律失常、靜脈血栓或齣血、難以糾正的低血壓.療效觀察指標包括:18箇月時嚴重傷殘髮生率和病死率,智能測驗運動髮育指數及認知髮育指數.結果 兩組均未齣現嚴重心律失常、低血壓和腎功能衰竭.至生後18箇月隨訪,共失訪6例(14.6%),其中SHC組和對照組的失訪率分彆為14.3%(3/21)和15.0%(3/20),差異無顯著性(P>0.05),實際有效病例SHC組為18例,對照組為17例.SHC組和對照組的死亡和嚴重傷殘聯閤髮生率分彆為22.2%(4/18)、52.9%(9/17),差異有顯著性(P<0.05).結論 SHC持續72 h治療新生兒HIE是可行和安全的,可降低神經繫統後遺癥髮生率及嚴重傷殘率.
목적 연구선택성두부아저온(SHC)치료신생인결양결혈성뇌병(HIE)적안전성급림상료효.방법 수집신생인중도HIE공54례,지입원96h유효병례41례,수궤분위SHC조(n=21)화대조조(n=20).SHC조환인생후6 h내개시급여SHC치료,비인부온도유지재(34.0±0.2)℃,직장온도유지>34.5℃,지속72 h,연후자연복온;대조조환인직장온도유지36.0～37.5℃.량조균진행심전도、혈압、경피양포화도、비인부온도화직장온도감측.관찰주요불량반응포괄:엄중심률실상、정맥혈전혹출혈、난이규정적저혈압.료효관찰지표포괄:18개월시엄중상잔발생솔화병사솔,지능측험운동발육지수급인지발육지수.결과 량조균미출현엄중심률실상、저혈압화신공능쇠갈.지생후18개월수방,공실방6례(14.6%),기중SHC조화대조조적실방솔분별위14.3%(3/21)화15.0%(3/20),차이무현저성(P>0.05),실제유효병례SHC조위18례,대조조위17례.SHC조화대조조적사망화엄중상잔연합발생솔분별위22.2%(4/18)、52.9%(9/17),차이유현저성(P<0.05).결론 SHC지속72 h치료신생인HIE시가행화안전적,가강저신경계통후유증발생솔급엄중상잔솔.
Objective To study the safety and efficacy of selective head cooling (SHC) with mild systemic hypotherrnia in neonates with HIE. Methods Fifty-four term infants with severe neonatal HIE were randomly assigned to the head cooling group (n=27) and control group (n=27). Forty-one infants in 96 h after admission were eligible for the study(SHC group n=21, control group n=20). In SHC group, the naso-pharyngeal temperature was maintained at (34.0±0.2) ℃ and rectal temperature maintained at 34～35 ℃ for 72 h, then rewarmed spontaneously. In control group, normal rectal temperature was maintained. During the period of the study, the infants of two groups were monitored on nasopharyngeal temperature, heart rate, respiratory rate,transcutaneous arterial oxygen saturation and blood pressure. Primary adverse effects inclu-ding severe arrhythmia, venous thrombosis or hemorrhage and severe hypotension were observed. The efficacy indicators including rate of death and severe disability, exercise and cognition development index were as-sessed. Results Severe arrhythmia, hypotension and renal failure were not found in both groups. Follow-up was conducted until postnatal 18 months and was not available in 6 babies (3 in SHC group and 3 in control group respectively). Death and severe disability occurred in 4 of 18 infants (22.2%)in SHC group and in 9 of 17 infants(52.9% ) in the control group respectively (P<0.05). Conclusion SHC for 72 h with mild systemic hypothermia in neonates with HIE is safe and effective. The therapy could reduce the risk of disabili-ty and handicap significantly.
