CAJ | 학술논문

目的亚低温已成为足月儿围生期窒息后神经保护的标准治疗方法,但主动降温(头部或全身)成本高,相对复杂,现探讨被动式降温治疗重度窒息足月儿的临床可行性.方法选取重度窒息足月儿32例,患儿均满足亚低温治疗标准,随机分为被动降温组(n=17)和主动降温组(n=15).主动降温组采用MTREALLONTM-体温调节系统,被动降温组采用自然降温法.亚低温治疗时间均为72 h,治疗结束后总结2组患儿的临床表现、生化指标以及临床疗效.结果 2组患儿治疗期间均无心律失常、低血糖、持续代谢性酸中毒、血源性感染,无局部寒冷损伤或出血现象.被动降温组患儿的直肠温度波动范围相对较宽[平均(33.47±0.71)℃],而主动降温组患儿直肠温度波动范围相对较窄[平均(33.66 ±0.29)℃],但2组平均直肠温度差异无统计学意义(t=1.941,P=0.055).在主动降温组中,l例患儿因窒息合并急性肾衰竭,家长要求放弃治疗,其余31例患儿均存活.2组存活患儿自行吃奶的日龄、住院天数、新生儿神经行为评定评分、颅脑超声及颅脑MRI异常比例差异均无统计学意义(P均＞0.05).结论被动降温方式在环境温度相对稳定的NICU可以便利地作为重度窒息足月儿的亚低温治疗手段,且无明显的临床不良反应.
목적 아저온이성위족월인위생기질식후신경보호적표준치료방법,단주동강온(두부혹전신)성본고,상대복잡,현탐토피동식강온치료중도질식족월인적림상가행성.방법 선취중도질식족월인32례,환인균만족아저온치료표준,수궤분위피동강온조(n=17)화주동강온조(n=15).주동강온조채용MTREALLONTM-체온조절계통,피동강온조채용자연강온법.아저온치료시간균위72 h,치료결속후총결2조환인적림상표현、생화지표이급림상료효.결과 2조환인치료기간균무심률실상、저혈당、지속대사성산중독、혈원성감염,무국부한랭손상혹출혈현상.피동강온조환인적직장온도파동범위상대교관[평균(33.47±0.71)℃],이주동강온조환인직장온도파동범위상대교착[평균(33.66 ±0.29)℃],단2조평균직장온도차이무통계학의의(t=1.941,P=0.055).재주동강온조중,l례환인인질식합병급성신쇠갈,가장요구방기치료,기여31례환인균존활.2조존활환인자행흘내적일령、주원천수、신생인신경행위평정평분、로뇌초성급로뇌MRI이상비례차이균무통계학의의(P균＞0.05).결론 피동강온방식재배경온도상대은정적NICU가이편리지작위중도질식족월인적아저온치료수단,차무명현적림상불량반응.
Objective Therapeutic hypothermia has become a standard neuroprotective treatment in term newborn infants following perinatal asphyxia,but active cooling with whole body surface or head cooling is both complex and expensive.The clinical feasibility of passive cooling in treatment of full term infants with severe asphyxia was investigated.Methods Thirty-two severe asphyxiated term newborns treated with hypothermia were analyzed,who were randomly divided into 2 groups:passive cooling group(n =17) and active cooling group(n =15).Active cooling group adopted MTRE ALLONTM-thermo regulatory systems,passive cooling group using natural cooling method.Hypothermia treatment time was 72 hours.At the end of treatment,the clinical manifestations,biochemical parameters and clinical efficacy of infants between the 2 groups were compared.Results During treatment all infants had no cardiac arrhythmia,hypoglycemia,sustained metabolic acidosis,blood-borne infections,local cold injury or bleeding.Infants in passive cooling group had a relatively wide range of rectal temperature fluctuations[average (33.47-0.71) ℃] and infants in active cooling group had a relatively narrow range of rectal temperature fluctuations[average (33.66 ± 0.29) ℃],but there was no statistically significant difference in their mean rectal temperature(t =1.941,P =0.055).One patient died in active cooling group,but there were no significant differences in suckling age,length of hospital stay,neonatal behavioral neurological assessment score,abnormal cranial ultrasound and MRI between the survivors of the two groups(all P ＞0.05).Conclusions In NICU,environmental temperature is relatively stable,passive cooling for asphyxiated newborns appears to be feasible for maintenance of hypothermia with a lower risk of adverse reactions.