全身与局部亚低温治疗新生儿窒息所致缺氧缺血性脑损伤疗效分析
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摘要
目的比较全身与局部亚低温治疗新生儿窒息所致缺氧缺血性脑损伤的疗效。方法选取2017年1月至2018年1月本院收治的70例窒息所致缺氧缺血性脑损伤新生儿为研究对象,按照等距随机抽样法将其分为对照组和观察组,每组各35例。对照组患儿接受局部亚低温治疗,观察组患儿接受全身亚低温治疗,比较两组患儿不良反应发生情况、自主吮奶时间、住院天数、神经行为测定评分、心率、呼吸频率、收缩压、血清学指标及治疗过程中并发症发生情况。结果观察组患儿不良反应发生率略低于对照组,组间比较差异无显著性(P> 0.05)。观察组患儿自主吮奶时间和住院天数均略短于对照组(P_均>0.05),新生儿神经行为测定评分显著高于对照组(P <0.05)。治疗前及治疗后24、48、72 h,两组患儿心率、呼吸频率及收缩压比较均无显著差异(P_均> 0.05)。治疗后24、48、72 h,观察组患儿血清肿瘤坏死因子-α、高迁移率族蛋白-1、特异性烯醇化酶水平均略低于对照组,但差异均无显著性(P_均> 0.05)。两组患儿治疗过程中并发症发生率比较无显著差异(P>0.05)。结论全身亚低温治疗新生儿窒息所致缺氧缺血性脑损伤的安全性较好,并发症发生率低。
Objective To compare the therapeutic effect of systemic hypothermia and focal mild hypothermia in the treatment of hypoxic-ischemia brain injury caused by neonate asphyxia. Method From January 2017 to January 2018, 70 neonates with hypoxicischemia brain injury caused by neonate asphyxia were selected as the subjects, and they were divided into control group and observation group according to the equidistance random sampling method, each group had 35 cases. Control group children received focal mild hypothermia treatment, observation group children received systemic hypothermia treatment. The incidence of adverse reactions, spontaneous sucking time, days of hospitalization, the score of neonatal neurobehavioral measurement, heart rate, respiratory frequency, systolic blood pressure and serological index were compared between the two groups. Result The incidence of adverse reactions in observation group was slightly lower than that in control group, and there was no significant difference between the two groups(P>0.05). The time of independent suckling and the days of hospitalization in observation group were slightly shorter than that in control group(P_(all)>0.05), and the score of neonatal neurobehavioral measurement was higher than that of control group(P < 0.05). There was no significant difference in heart rate, respiratory frequency and systolic pressure between the two groups before and after treatment of 24, 48, 72 h(P_(all)>0.05). After treatment 24, 48, 72 h, the serum tumor necrosis factor-α, high mobility group protein-1, and specific enolase in observation group were slightly lower than that of control group, but the differences were not significant(P_(all)> 0.05). There was no significant difference in the incidence of complications between the two groups(P_(all)> 0.05). Conclusion Hypoxic-ischemic brain injury caused by neonatal asphyxia treated by systemic hypothermia is safe and has lower incidence of complications.
Objective To compare the therapeutic effect of systemic hypothermia and focal mild hypothermia in the treatment of hypoxic-ischemia brain injury caused by neonate asphyxia. Method From January 2017 to January 2018, 70 neonates with hypoxicischemia brain injury caused by neonate asphyxia were selected as the subjects, and they were divided into control group and observation group according to the equidistance random sampling method, each group had 35 cases. Control group children received focal mild hypothermia treatment, observation group children received systemic hypothermia treatment. The incidence of adverse reactions, spontaneous sucking time, days of hospitalization, the score of neonatal neurobehavioral measurement, heart rate, respiratory frequency, systolic blood pressure and serological index were compared between the two groups. Result The incidence of adverse reactions in observation group was slightly lower than that in control group, and there was no significant difference between the two groups(P>0.05). The time of independent suckling and the days of hospitalization in observation group were slightly shorter than that in control group(P_(all)>0.05), and the score of neonatal neurobehavioral measurement was higher than that of control group(P < 0.05). There was no significant difference in heart rate, respiratory frequency and systolic pressure between the two groups before and after treatment of 24, 48, 72 h(P_(all)>0.05). After treatment 24, 48, 72 h, the serum tumor necrosis factor-α, high mobility group protein-1, and specific enolase in observation group were slightly lower than that of control group, but the differences were not significant(P_(all)> 0.05). There was no significant difference in the incidence of complications between the two groups(P_(all)> 0.05). Conclusion Hypoxic-ischemic brain injury caused by neonatal asphyxia treated by systemic hypothermia is safe and has lower incidence of complications.
引文
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[13]赵湛元.亚低温疗法对脑外伤患者细胞炎症因子的影响[J].中国实用神经疾病杂志,2014,17(11):18-20.
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[15]陈玉熹,缪心军,陈红辉,等.亚低温治疗对心肺复苏后大鼠S100B蛋白水平的影响和脑组织保护作用的研究[J].现代实用医学,2015,27(12):1569-1570,1697.
[16]黄珠莲.亚低温治疗法在新生儿窒息复苏后的应用效果及护理措施的探讨[J].中国实用医药,2016,11(29):234-235.
[17]杨艳秋.亚低温联合促红细胞生成素治疗新生儿窒息后缺氧缺血脑损伤的疗效[J].中国实用神经疾病杂志,2016,19(12):46-48.
[18]邓伟驰.全身亚低温治疗新生儿重度窒息的临床疗效分析[J].中国医学创新,2016,13(10):136-139.
[19]林祥副,谭志勇.亚低温治疗对围生期窒息新生儿氧化应激反应和预后的影响[J].山东医药,2015,55(21):43-45.
[20]罗雅娟,周从阳.亚低温治疗对心肺复苏后脑保护作用的研究进展[J].江西医药,2011,46(4):381-384.
[2]Datta V.Therapeutic Hypothermia for Birth Asphyxia in Neonates[J].Indian J Pediatr,2017,84(3):219-226.
[3]金汉珍,黄德珉,关希吉.实用新生儿学[M].3版.北京:人民卫生出版社,2003:32-38.
[4]王洁洁.亚低温治疗新生儿缺氧缺血性脑病的研究进展[J].中华全科医学,2015,13(12):2026-2029.
[5]白妙琴,赵水英,孙健伟,等.头颅局部亚低温治疗新生儿缺氧缺血性脑病的护理[J].河南职工医学院学报,2007,19(6):558-559.
[6]刘彩霞.新生儿缺氧缺血性脑病患儿采用选择性头部亚低温治疗的临床效果[J].中国妇幼保健,2018,33(23):5466-5468.
[7]刘刚,李顺品,田春.血清肿瘤坏死因子-α、高迁移率族蛋白-1、特异性烯醇化酶在新生儿窒息早期诊断中的价值[J].中国妇幼保健,2017,32(21):5305-5307.
[8]王耀龙.早期亚低温联合神经节苷脂对新生儿窒息并发缺血缺氧性脑病患儿的影响[J].中国初级卫生保健,2017,31(2):26,33-35.
[9]王来栓,程国强,周文浩,等.亚低温治疗胎龄大于35周龄新生儿缺氧缺血性脑病效果及安全性的荟萃分析[J].中华医学杂志,2012,93(20):1400-1404.
[10]孙运梅.新生儿窒息新诊断标准在临床实践中的认识和体会[J].中国医药科学,2016,6(24):62-65.
[11]付雪静.重型脑出血患者亚低温脑保护治疗的临床护理[J].长春中医药大学学报,2008,24(6):737-738.
[12]吴联强,王瑞泉,张伟峰,等.全身亚低温治疗中重度新生儿缺氧缺血性脑病的效果及安全性[J].中华围产医学杂志,2015,18(9):670-674.
[13]赵湛元.亚低温疗法对脑外伤患者细胞炎症因子的影响[J].中国实用神经疾病杂志,2014,17(11):18-20.
[14]武艳.鼠神经生长因子联合亚低温疗法治疗新生儿缺氧缺血性脑病的疗效分析[J].中国妇幼保健,2017,32(8):1804-1805.
[15]陈玉熹,缪心军,陈红辉,等.亚低温治疗对心肺复苏后大鼠S100B蛋白水平的影响和脑组织保护作用的研究[J].现代实用医学,2015,27(12):1569-1570,1697.
[16]黄珠莲.亚低温治疗法在新生儿窒息复苏后的应用效果及护理措施的探讨[J].中国实用医药,2016,11(29):234-235.
[17]杨艳秋.亚低温联合促红细胞生成素治疗新生儿窒息后缺氧缺血脑损伤的疗效[J].中国实用神经疾病杂志,2016,19(12):46-48.
[18]邓伟驰.全身亚低温治疗新生儿重度窒息的临床疗效分析[J].中国医学创新,2016,13(10):136-139.
[19]林祥副,谭志勇.亚低温治疗对围生期窒息新生儿氧化应激反应和预后的影响[J].山东医药,2015,55(21):43-45.
[20]罗雅娟,周从阳.亚低温治疗对心肺复苏后脑保护作用的研究进展[J].江西医药,2011,46(4):381-384.
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