中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
9期
670-674
,共5页
吴联强%王瑞泉%张伟峰%陈冬梅
吳聯彊%王瑞泉%張偉峰%陳鼕梅
오련강%왕서천%장위봉%진동매
缺氧缺血,脑%低温,人工%婴儿,新生
缺氧缺血,腦%低溫,人工%嬰兒,新生
결양결혈,뇌%저온,인공%영인,신생
Hypoxia-ischemia,brain%Hypothermia,induced%Infant,newborn
目的 探讨全身亚低温治疗中、重度新生儿缺氧缺血性脑病的临床疗效及安全性.方法 采取回顾性对照研究方法.选择2011年1月1日至201 5年5月31日福建省泉州市儿童医院收治并完成随访的75例中、重度缺氧缺血性脑病患儿,根据治疗措施分为常规治疗组33例和亚低温治疗组42例,分别在治疗前描记振幅整合脑电图,7日龄时行振幅整合脑电图和头颅MRI,14日龄时行新生儿行为神经评分,18月龄时采用标准化贝利婴幼儿发展量表测定智力发育指数和心理运动发育指数.同时,观察治疗期间的不良反应.采用两独立样本t检验和x2检验比较组间治疗效果及不良反应发生率的差异. 结果 亚低温治疗组无死亡病例,常规治疗组死亡6例.7日龄时亚低温治疗组头颅MRI正常的比例高于常规治疗组[43％(18/42)与18％(6/33),x2=4.814].存活患儿7日龄时亚低温治疗组振幅整合脑电图最高电压和最低电压分别为(31.3±2.4)和(13.5±2.1)μV,均高于治疗前[分别为(18.1±2.2)和(6.1±1.5) μV,t值分别为8.591和5.314],也均高于常规治疗组患儿7日龄时[分别为(25.2±3.1)和(9.3±3.1)μV,t值分别为6.376和4.725],差异均有统计学意义(P值均≤ 0.05).与常规治疗组相比,亚低温治疗组严重伤残发生率[21％ (9/42)与45％(15/33),x2=4.902]及病死率明显下降[0％(0/42)与18％(6/33),x2=6.098],14日龄时新生儿行为神经评分[(39.4±2.6)与(35.3±2.4)分,t=3.316]、1 8月龄时智力发育指数(96.3±13.2与84.3±10.6,t=7.893)和心理运动发育指数明显提高(98.2±16.8与85.4±13.2,t=8.753),差异均有统计学意义(P值均≤ 0.05).亚低温治疗过程中未发生寒冷损伤综合征,其他不良反应包括12例电解质紊乱,8例血糖异常,7例肝肾功能异常,6例感染和4例心动过缓,与常规治疗组差异均无统计学意义(P值均＞ 0.05). 结论 全身亚低温治疗可显著降低中、重度HIE患儿的病死率和严重伤残发生率,明显改善0～18月龄时的神经运动发育结局.
目的 探討全身亞低溫治療中、重度新生兒缺氧缺血性腦病的臨床療效及安全性.方法 採取迴顧性對照研究方法.選擇2011年1月1日至201 5年5月31日福建省泉州市兒童醫院收治併完成隨訪的75例中、重度缺氧缺血性腦病患兒,根據治療措施分為常規治療組33例和亞低溫治療組42例,分彆在治療前描記振幅整閤腦電圖,7日齡時行振幅整閤腦電圖和頭顱MRI,14日齡時行新生兒行為神經評分,18月齡時採用標準化貝利嬰幼兒髮展量錶測定智力髮育指數和心理運動髮育指數.同時,觀察治療期間的不良反應.採用兩獨立樣本t檢驗和x2檢驗比較組間治療效果及不良反應髮生率的差異. 結果 亞低溫治療組無死亡病例,常規治療組死亡6例.7日齡時亞低溫治療組頭顱MRI正常的比例高于常規治療組[43％(18/42)與18％(6/33),x2=4.814].存活患兒7日齡時亞低溫治療組振幅整閤腦電圖最高電壓和最低電壓分彆為(31.3±2.4)和(13.5±2.1)μV,均高于治療前[分彆為(18.1±2.2)和(6.1±1.5) μV,t值分彆為8.591和5.314],也均高于常規治療組患兒7日齡時[分彆為(25.2±3.1)和(9.3±3.1)μV,t值分彆為6.376和4.725],差異均有統計學意義(P值均≤ 0.05).與常規治療組相比,亞低溫治療組嚴重傷殘髮生率[21％ (9/42)與45％(15/33),x2=4.902]及病死率明顯下降[0％(0/42)與18％(6/33),x2=6.098],14日齡時新生兒行為神經評分[(39.4±2.6)與(35.3±2.4)分,t=3.316]、1 8月齡時智力髮育指數(96.3±13.2與84.3±10.6,t=7.893)和心理運動髮育指數明顯提高(98.2±16.8與85.4±13.2,t=8.753),差異均有統計學意義(P值均≤ 0.05).亞低溫治療過程中未髮生寒冷損傷綜閤徵,其他不良反應包括12例電解質紊亂,8例血糖異常,7例肝腎功能異常,6例感染和4例心動過緩,與常規治療組差異均無統計學意義(P值均＞ 0.05). 結論 全身亞低溫治療可顯著降低中、重度HIE患兒的病死率和嚴重傷殘髮生率,明顯改善0～18月齡時的神經運動髮育結跼.
목적 탐토전신아저온치료중、중도신생인결양결혈성뇌병적림상료효급안전성.방법 채취회고성대조연구방법.선택2011년1월1일지201 5년5월31일복건성천주시인동의원수치병완성수방적75례중、중도결양결혈성뇌병환인,근거치료조시분위상규치료조33례화아저온치료조42례,분별재치료전묘기진폭정합뇌전도,7일령시행진폭정합뇌전도화두로MRI,14일령시행신생인행위신경평분,18월령시채용표준화패리영유인발전량표측정지력발육지수화심리운동발육지수.동시,관찰치료기간적불량반응.채용량독립양본t검험화x2검험비교조간치료효과급불량반응발생솔적차이. 결과 아저온치료조무사망병례,상규치료조사망6례.7일령시아저온치료조두로MRI정상적비례고우상규치료조[43％(18/42)여18％(6/33),x2=4.814].존활환인7일령시아저온치료조진폭정합뇌전도최고전압화최저전압분별위(31.3±2.4)화(13.5±2.1)μV,균고우치료전[분별위(18.1±2.2)화(6.1±1.5) μV,t치분별위8.591화5.314],야균고우상규치료조환인7일령시[분별위(25.2±3.1)화(9.3±3.1)μV,t치분별위6.376화4.725],차이균유통계학의의(P치균≤ 0.05).여상규치료조상비,아저온치료조엄중상잔발생솔[21％ (9/42)여45％(15/33),x2=4.902]급병사솔명현하강[0％(0/42)여18％(6/33),x2=6.098],14일령시신생인행위신경평분[(39.4±2.6)여(35.3±2.4)분,t=3.316]、1 8월령시지력발육지수(96.3±13.2여84.3±10.6,t=7.893)화심리운동발육지수명현제고(98.2±16.8여85.4±13.2,t=8.753),차이균유통계학의의(P치균≤ 0.05).아저온치료과정중미발생한랭손상종합정,기타불량반응포괄12례전해질문란,8례혈당이상,7례간신공능이상,6례감염화4례심동과완,여상규치료조차이균무통계학의의(P치균＞ 0.05). 결론 전신아저온치료가현저강저중、중도HIE환인적병사솔화엄중상잔발생솔,명현개선0～18월령시적신경운동발육결국.
Objective To explore the efficacy and safety of systemic mild hypothermia in management of neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE).Methods A retrospective case-control study was conducted on 75 neonates with moderate or severe HIE,who were admitted to the Neonatal Intensive Care Unit of Teaching Hospital of Fujian Medical University (Quanzhou Children's Hospital) from January 1,2011 to May 31,2015.The 75 neonates were divided into two groups,the conventional treatment group (33 cases,control group) and the mild hypothermia treatment group (42 cases,hypothermia group).Sequential management protocol for all subjects was followed,including amplitude-integrated electroencephalogram (aEEG) before treatment,aEEG and brain MRI at one week after birth,neonatal behavioral neurological assessment (NBNA) on the 14th day after birth,and determination of mental and psychomotor development index with Bayley Scales of Infant and Toddler Developmental at 18 months old.Adverse reactions,serious disability cases and deaths during the study were also recorded.Two sample-t test and Chi-square test were as statistical methods.Results There were six death cases in the control group,but on one died in the hypothermia group.In the survivals,The maximum voltage and minimum voltage in the hypothermia group were higher at 7-day old than that before treatment [maximum voltage:(31.3 ±2.4) vs (18.1± 2.2) μ V;minimum voltage:(13.5±2.1) vs (6.1 ±1.5) μ V,t=8.591 and 5.314,both P ＜ 0.05],and also higher than that of control group [(25.2±3.1) and (9.3±3.1) μV,respectively,both P ≤ 0.05].Compared with the control group,there were more babies with normal head MRI [43％(18/42) vs 18％(6/33),x2=4.814,P ≤ 0.05] in the hypothermia group at 7-day old and less cases of severe disability [21％(9/42) vs 45％(15/33),x2=4.902,P ≤ 0.05] and deaths [0％(0/42) vs 18％(6/33),x2=6.098,P ≤ 0.05].Higher NBNA score at 14 day and Bayley developmental index at 18 months were shown in the hypothermia group than in the control (39.4±2.6 vs 35.3 ±2.4,t=3.316;mental development index:96.3± 13.2 vs 84.3 ± 10.6,t=7.893;psychomotor development index:98.2 ±16.8 vs 85.4±13.2,t=8.753,all P ≤ 0.05).The adverse effects of hypothermia treatment included electrolyte imbalance (n=12),abnormal blood glucose level (n=8),hepatic and renal dysfunction (n=7),infections (n=6) and bradycardiac (n=4),and no cold injury syndrome case was reported.However,none of the above had significant difference compared with the control group (P ＞ 0.05).Conclusions Systemic mild hypothermia treatment is effective in reducing mortality rate and major disability rate in neonates with moderate or severe HIE and improves the neuromotor development when babies grow up to 18-month-old.
