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目的:探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病(HIE)不同治疗时间窗对神经系统的保护作用。方法:选择2008年1月至2012年10月我院新生儿科收治的中、重度HIE患儿,随机分为生后3 h内进行选择性头部亚低温治疗组、生后3~6 h治疗组、生后6 h以上治疗组及对照组。对各组患儿生后28 d行新生儿20项行为神经测定(NBNA)评分,同时监测严重伤残例数及死亡例数。结果:共117例患儿完成了治疗和随访,其中亚低温治疗生后<3 h组30例,3~6 h组29例,>6 h组29例,对照组29例。四组NBNA评分分别为(38.5±5.5)分、(37.6±5.5)分、(30.1±4.9)分、(31.2±4.4)分,<3 h组和3~6h组患儿生后28 d NBNA评分均高于>6 h组和对照组(P<0.05),而<3 h组和3~6 h组之间以及>6 h组和对照组之间的NBNA评分比较差异无统计学意义(P>0.05);<3 h组和3~6 h组患儿严重伤残率(3.33%&3.44%)和病死率(0%&0%)均低于>6 h组和对照组(17.2%&13.8%,10.3%&10.3%)(P<0.05),而<3 h组和3~6 h组之间以及>6 h组和对照组之间严重伤残率和病死率比较差异无统计学意义(P>0.05)。结论:生后<6 h开始的选择性头部亚低温治疗对新生儿神经系统近期和远期功能恢复都有明显疗效,明显优于生后6 h开始的治疗,>6 h则明显无效,而进一步提前开始治疗的时间并无更好的临床疗效。
Objective: To explore the neuroprotective effects of selective head mild hypothermia on neonatal hypoxic-ischemic encephalopathy (HIE) in different treatment time windows. Methods: From January 2008 to October 2012 in our hospital neonates admitted to moderate and severe HIE were randomly divided into 3 h after birth for selective head hypothermia treatment group, 3 to 6 h after treatment Group, 6 h after birth, the treatment group and the control group. Twenty neonates with behavioral neurological assessment (NBNA) were scored on the 28th day after birth, and the number of serious injuries and the number of deaths were monitored. Results: A total of 117 children were treated and followed up. Among them, 30 cases were treated with mild hypothermia for 3 hours, 29 cases were treated with 3 ~ 6 hours, 29 cases were treated with> 6 hours and 29 cases were treated with mild hypothermia. The NBNA scores were (38.5 ± 5.5), (37.6 ± 5.5), (30.1 ± 4.9) and (31.2 ± 4.4) in the four groups respectively. The NBNA scores in the groups of <3 h and 3 ~ (P <0.05). However, there was no significant difference in NBNA score between <3 h group and 3 h to 6 h group and> 6 h group and control group (P <0.05) P <0.05). Severe disability (3.33% & 3.44%) and mortality (0% & 0%) in children <3 h and 3 h were lower than those in> 6 h and control groups % & 13.8%, 10.3% & 10.3%, respectively) (P <0.05), while severe disability and mortality between the 3 h and 3 h and 6 h groups and the control group The difference was not statistically significant (P> 0.05). CONCLUSION: Selective head hypothermia treatment starting 6 h after birth has obvious curative effect on the recovery of nervous system in short term and long term, which is obviously better than the treatment started 6 h after birth. It is obviously invalid for> 6 h, However, there is no better clinical outcome at the time of further initiation of treatment.