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自1981年Donn等首次报道应用苯巴比妥预防早产儿脑室内出血(IVH)以来,该院对出生体重≤1800g的早产儿应用苯巴比妥成为常规。这些早产儿在生后6小时内接受20mg/kg的负荷量,24小时后子维持量5mg/kg·d共4～5天。为评价该药的实际预防成效,本文复习了该院1985～1989年内所有早产儿的病史。5年内总的IVH发生率为27.5％(168/612例),其中严重IVH占39.9％(69/168例),而在23例因疏忽而未用苯巴比妥的早产儿中,其发生率分别为39.1%和55.6％。给予负荷量的平均时间为生后4.3小时。在生后4小时内给予负荷量,其IVH发生率明显降低(25.9％ vs.32.8％)。外院出生的患儿IVH发生率明显高于本院患儿(45.3％ vs.23.0％)。本文结果再次证实Donn等研究,即苯巴比妥能够降低IVH发生率及IVH的严重度。但该药并不是唯一减少IVH发生的手段,临床早期及时谨慎地处理,尤其是维持血压及血气值的稳定,保证合适的脑灌注,对于降低IVH起重要作用。
Since 1981, when Donn et al. First reported the use of phenobarbital to prevent intraventricular hemorrhage (IVH) in preterm infants, the use of phenobarbital in preterm infants weighing <1800g has become routine. These preterm infants receive a loading of 20 mg / kg within 6 hours of birth and a sub-maintenance dose of 5 mg / kg.d for 4 to 5 days after 24 hours. In order to evaluate the actual preventive effect of this medicine, this article reviews the history of all premature infants in the hospital from 1985 to 1989. The overall incidence of IVH in 5 years was 27.5% (168/612), with severe IVH accounting for 39.9% (69/168), whereas in 23 cases of preterm infants who had been negligent with phenobarbital, their incidence The rates were 39.1% and 55.6% respectively. The average load given was 4.3 hours after birth. The IVH rate was significantly reduced (25.9% vs.32.8%) during 4 hours after birth. The incidence of IVH in infants born outside the hospital was significantly higher than that in our hospital (45.3% vs.23.0%). Our results confirm once again Donn and other studies, that phenobarbital can reduce the incidence of IVH and the severity of IVH. However, this medicine is not the only means to reduce the incidence of IVH. It should be handled with caution in early and early stages of the disease. In particular, maintaining the stability of blood pressure and blood gas and ensuring proper cerebral perfusion may play an important role in reducing IVH.