中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
24期
1858-1861
,共4页
蔡成%龚小慧%裘刚%魏东%胡勇%颜崇兵%孙婧婧
蔡成%龔小慧%裘剛%魏東%鬍勇%顏崇兵%孫婧婧
채성%공소혜%구강%위동%호용%안숭병%손청청
亚低温%婴儿,新生%缺氧缺血性脑病%预后%随访
亞低溫%嬰兒,新生%缺氧缺血性腦病%預後%隨訪
아저온%영인,신생%결양결혈성뇌병%예후%수방
Mild hypothermia%Infant,newborn%Hypoxic-ischemic encephalopathy%Prognosis%Follow-up
目的 探讨亚低温(MH)治疗中重度新生儿缺氧缺血性脑病(HIE)的疗效及安全性,并随访出院后18月龄患儿神经运动发育情况.方法 选取2007年1月至2013年12月在新生儿重症监护病房(NICU)住院治疗的中重度HIE患儿61例,依据上海市儿童医院NICU购买MH治疗仪前后分为常规治疗组(25例)和MH治疗组(36例),分别在治疗前、治疗72 h描记振幅整合脑电图(aEEG),记录出生28 d新生儿20项行为神经测定评分(NBNA),采用标准化的贝利(Bayley)婴儿发育量表对出院后18月龄患儿进行神经行为发育评价,同时观察MH治疗的不良反应、严重伤残例数及死亡例数.结果 MH治疗组治疗前aEEG与常规治疗组比较差异无统计学意义[最高电压:(22.4±3.1) μV比(18.6±±2.5) μV,最低电压:(8.2±2.6)μV比(6.5±1.9)μV,t=1.264、0.852,P均＞0.05];但治疗72 h描记aEEG比较差异有统计学意义[最高电压:(24.1±3.2)μV比(30.6±2.8) μV,最低电压:(9.7±3.4)μV比(13.3±2.2) μV,t=6.376、4.257,P均＜0.05],MH治疗组严重伤残例数[24.0％(6/25例)比5.6％(2/36例)x22=4.405,P＜0.05]及死亡例数[16.0％(4/25例)比0(0/36例),x2 =6.164,P＜0.05]明显下降,出生28 d NBNA[(35.9±±2.1)比(39.1±1.6),t=3.361,P＜0.05]、随访18月龄标准化的Bayley婴儿发育量表进行神经行为发育评价差异有统计学意义[神经发育指数(MDI):(85.2±10.7)比(96.5±13.1),t=7.839,P＜0.05].MH治疗过程中极少数发生呼吸暂停、凝血功能异常及心律失常等不良反应.结论 MH治疗中重度HIE安全有效,可显著降低中重度HIE患儿病死率,改善0～18月龄婴幼儿神经系统发育障碍,明显提高婴幼儿Bayley发育量表神经行为发育评分.
目的 探討亞低溫(MH)治療中重度新生兒缺氧缺血性腦病(HIE)的療效及安全性,併隨訪齣院後18月齡患兒神經運動髮育情況.方法 選取2007年1月至2013年12月在新生兒重癥鑑護病房(NICU)住院治療的中重度HIE患兒61例,依據上海市兒童醫院NICU購買MH治療儀前後分為常規治療組(25例)和MH治療組(36例),分彆在治療前、治療72 h描記振幅整閤腦電圖(aEEG),記錄齣生28 d新生兒20項行為神經測定評分(NBNA),採用標準化的貝利(Bayley)嬰兒髮育量錶對齣院後18月齡患兒進行神經行為髮育評價,同時觀察MH治療的不良反應、嚴重傷殘例數及死亡例數.結果 MH治療組治療前aEEG與常規治療組比較差異無統計學意義[最高電壓:(22.4±3.1) μV比(18.6±±2.5) μV,最低電壓:(8.2±2.6)μV比(6.5±1.9)μV,t=1.264、0.852,P均＞0.05];但治療72 h描記aEEG比較差異有統計學意義[最高電壓:(24.1±3.2)μV比(30.6±2.8) μV,最低電壓:(9.7±3.4)μV比(13.3±2.2) μV,t=6.376、4.257,P均＜0.05],MH治療組嚴重傷殘例數[24.0％(6/25例)比5.6％(2/36例)x22=4.405,P＜0.05]及死亡例數[16.0％(4/25例)比0(0/36例),x2 =6.164,P＜0.05]明顯下降,齣生28 d NBNA[(35.9±±2.1)比(39.1±1.6),t=3.361,P＜0.05]、隨訪18月齡標準化的Bayley嬰兒髮育量錶進行神經行為髮育評價差異有統計學意義[神經髮育指數(MDI):(85.2±10.7)比(96.5±13.1),t=7.839,P＜0.05].MH治療過程中極少數髮生呼吸暫停、凝血功能異常及心律失常等不良反應.結論 MH治療中重度HIE安全有效,可顯著降低中重度HIE患兒病死率,改善0～18月齡嬰幼兒神經繫統髮育障礙,明顯提高嬰幼兒Bayley髮育量錶神經行為髮育評分.
목적 탐토아저온(MH)치료중중도신생인결양결혈성뇌병(HIE)적료효급안전성,병수방출원후18월령환인신경운동발육정황.방법 선취2007년1월지2013년12월재신생인중증감호병방(NICU)주원치료적중중도HIE환인61례,의거상해시인동의원NICU구매MH치료의전후분위상규치료조(25례)화MH치료조(36례),분별재치료전、치료72 h묘기진폭정합뇌전도(aEEG),기록출생28 d신생인20항행위신경측정평분(NBNA),채용표준화적패리(Bayley)영인발육량표대출원후18월령환인진행신경행위발육평개,동시관찰MH치료적불량반응、엄중상잔례수급사망례수.결과 MH치료조치료전aEEG여상규치료조비교차이무통계학의의[최고전압:(22.4±3.1) μV비(18.6±±2.5) μV,최저전압:(8.2±2.6)μV비(6.5±1.9)μV,t=1.264、0.852,P균＞0.05];단치료72 h묘기aEEG비교차이유통계학의의[최고전압:(24.1±3.2)μV비(30.6±2.8) μV,최저전압:(9.7±3.4)μV비(13.3±2.2) μV,t=6.376、4.257,P균＜0.05],MH치료조엄중상잔례수[24.0％(6/25례)비5.6％(2/36례)x22=4.405,P＜0.05]급사망례수[16.0％(4/25례)비0(0/36례),x2 =6.164,P＜0.05]명현하강,출생28 d NBNA[(35.9±±2.1)비(39.1±1.6),t=3.361,P＜0.05]、수방18월령표준화적Bayley영인발육량표진행신경행위발육평개차이유통계학의의[신경발육지수(MDI):(85.2±10.7)비(96.5±13.1),t=7.839,P＜0.05].MH치료과정중겁소수발생호흡잠정、응혈공능이상급심률실상등불량반응.결론 MH치료중중도HIE안전유효,가현저강저중중도HIE환인병사솔,개선0～18월령영유인신경계통발육장애,명현제고영유인Bayley발육량표신경행위발육평분.
Objective To explore the efficacy and safety of mild hypothermia (MH) in treating the infants with moderate-to-severe neonatal hypoxic-ischemic encephalopathy(HIE),and to make a follow-up of the nerve motor development of the infants at 18 months old after discharge.Methods Totally 61 neonates with moderate-to-severe HIE in Neonatal Intensive Care Unit (NICU) from Jan.2007 to Dec.2013 were retrospectively analyzed.According to before and after MH therapeutic apparatus was used by NICU of Shanghai Children's Hospital,61 neonates of HIE were divided into 2 groups,the conventional treatment group(25 cases) and MH treatment group(36 cases).The patients in both groups were measured respectively by using the amplitude integrated electroencephalography (aEEG) before MH treatment and at 72 hours after M H treatment,by neonatal behavioral neurological assessment(NBNA) on the 28th day after birth,and by adopting Bayley Scales of Infant Development at 18 months old.The adverse reactions,serious disability cases and deaths of MH treatment were recorded.Results Compared with the conventional treatment group,aEEG recording before treatment showed no statistically significant differences in MH treatment group [maximum voltage:(22.4 ±3.1) μV vs(18.6 ±2.5) μV,maximum voltage:(8.2 ±2.6)μV vs(6.5 ±1.9) μV,t =1.264,0.852,all P ＞ 0.05].However,aEEG recording at 72 h after treatment showed statistically significant differences in MH treatment group [maximum voltage:(24.1 ± 3.2) μV vs (30.6 ± 2.8) μV,maximum voltage:(9.7 ± 3.4) μV vs (13.3 ± 2.2) μV,t =6.376,4.257,all P ＜ 0.05].Severe disability cases [24.0％ (6/25 cases) vs 5.6％ (2/36 cases),x2 =4.405,P ＜ 0.05] and deaths [16.0％ (4/25 cases) vs 0 (0/36 case),x2 =6.1 64,P ＜ 0.05] in MH treatment group were significantly decreased,and there was significantly difference in NBNA on the 28th day after birth[(35.9 ± 2.1) vs(39.1-± 1.6),t =3.361,P ＜ 0.05],and scales of neurobehavioral evaluation through follow-up of 18 months old [mental development index (MDI):(85.2 ± 10.7) vs (96.5-± 13.1),t =7.839,P ＜ 0.05].Very few neonates had apnea,coagulation dysfunction,arrhythmia and other adverse reactions in MH treatment course.Conclusions MH treating moderate-to-severe HIE is safe and effective.MH is effective in reducing death and major disabilities in neonates with moderate-to-severe HIE and without significant side effects.MH can obviously improve the development of nervous system disorders in 0-18 months infants,and can significantly improve these infants' Bayley developmental scale neurobehavioral scores.
