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目的观察神经节苷酯辅助亚低温治疗早产儿缺氧缺血性脑病的疗效。方法将73例缺氧缺血性脑病早产儿根据治疗方案分为两组:对照组(43例)给予吸氧等常规治疗并于出生6 h内给予头部亚低温;观察组(30例)在对照组基础上给予神经节苷酯静脉注射,20 mg/次,1次/d。治疗3个疗程后,观察治疗总有效率、病死率、症状(意识、反射、肌张力、惊厥)恢复或者改善时间。比较两组患儿治疗前,治疗后15 d、30 d的NBNA评分。随访12个月,比较两组的随访结果。结果治疗3个疗程后,观察组的治疗总有效率为90.0%,显著高于对照组的69.8%(P=0.040)。观察组的意识恢复时间、惊厥改善时间等均显著短于对照组,差异有统计学意义(P<0.05)。治疗前,两组的NABA评分比较无显著差异(P>0.05);治疗后15 d、30 d,两组的NABA评分均改善,组内比较有显著差异(P<0.05),观察组显著高于对照组,组间比较有显著差异(P<0.05)。随访4个月,两组的PDI、MDI评分比较,差异无统计学意义(P>0.05);随访8个月、12个月,两组的PDI、MDI评分均显著改善(P<0.05),且观察组的改善程度显著优于对照组(P<0.05)。两组的病死率及不良反应发生率比较,差异无统计学意义(P>0.05)。结论神经节苷酯辅助亚低温治疗早产儿缺氧缺血性脑病有助于改善临床症状,提高治愈率,减少神经系统后遗症,且不会增加不良反应的发生,值得临床上推广应用。
Objective To observe the effect of ganglioside-assisted mild hypothermia on hypoxic-ischemic encephalopathy in premature infants. Methods 73 premature infants with hypoxic-ischemic encephalopathy were divided into two groups according to the treatment regimen: the control group (43 cases) received conventional therapy such as oxygen inhalation and given head hypothermia within 6 hours of birth; the observation group (30 cases) In the control group on the basis of ganglioside given intravenously, 20 mg / time, 1 time / d. After 3 courses of treatment, observe the total effective rate of treatment, case fatality, symptoms (consciousness, reflex, muscle tone, convulsion) recovery or improvement of time. The NBNA scores of the two groups before treatment, 15 days and 30 days after treatment were compared. The patients were followed up for 12 months and the follow-up results of the two groups were compared. Results After 3 courses of treatment, the total effective rate in the observation group was 90.0%, which was significantly higher than that in the control group (69.8%, P = 0.040). The recovery time of consciousness and the time of improvement of convulsion in the observation group were significantly shorter than those in the control group, with significant difference (P <0.05). Before treatment, there was no significant difference in NABA score between the two groups (P> 0.05). The NABA scores of both groups were improved on the 15th and 30th day after treatment (P <0.05), and the observation group was significantly higher In the control group, there was significant difference between the two groups (P <0.05). There was no significant difference in PDI and MDI between the two groups (P> 0.05). After 8 months and 12 months of follow-up, the PDI and MDI scores of both groups were significantly improved (P <0.05) And the observation group improved significantly better than the control group (P <0.05). Two groups of mortality and adverse reactions, the difference was not statistically significant (P> 0.05). Conclusion Ganglioside-assisted hypothermia treatment of hypoxic-ischemic encephalopathy in preterm infants may help to improve the clinical symptoms, improve the cure rate, reduce the nervous system sequelae, and will not increase the incidence of adverse reactions, which is worth popularizing in clinic.