论文部分内容阅读
目的 研究选择性头部降温对足月新生儿窒息后缺氧缺血性脑损伤 (hypoxic ischemicbraindamage ,HIBD)治疗的安全性和神经保护作用。方法 将 18例中重度窒息的足月新生儿随机分为治疗组 (11例 )和对照组 (7例 )。治疗组采用选择性头部降温方法 ,维持鼻咽温度为 (34 0± 0 2 )℃ ,持续 72h ;对照组不进行降温治疗。于生后 6 2～ 72h采血检测肌钙蛋白 T、β2 微球蛋白、D 二聚体 ,同时检测尿 β2 微球蛋白和脑脊液 (CSF)神经烯醇化酶 (NSE)等。于治疗前、生后 7～ 10d和生后 3个月进行常规 16导联EEG检测 ,并分别采用新生儿神经行为评分 (NBNA)、婴幼儿发育量表 (CDCC)进行神经行为发育评价。结果 治疗组NSE为 (18 1± 2 1) μg/L ,对照组为 (2 4 6± 5 3) μg/L(t =2 0 4,P <0 0 5 ) ;治疗组患儿生后 2 8dNBNA为 (37± 2 )分 ,对照组为 (32± 3)分 (t =1 83,P <0 0 5 )。两组患儿血 β2 微球蛋白、肌钙蛋白 T、D 二聚体以及尿 β2 微球蛋白均明显升高 ,但两组差异无显著性(P均 >0 0 5 )。结论 初步研究显示 ,选择性头部降温对足月窒息新生儿具有神经保护作用 ,体温维持 34 5℃以上是安全的。
Objective To investigate the safety and neuroprotective effects of selective head cooling on neonatal hypoxic ischemic brain injury (HIBD) after full-term neonatal asphyxia. Methods 18 full-term neonates with moderate to severe asphyxia were randomly divided into treatment group (n = 11) and control group (n = 7). The treatment group with selective head cooling method, maintaining the nasopharyngeal temperature (34 0 ± 0 2) ℃, sustained 72h; control group without cooling treatment. Blood samples were taken for detection of troponin T, β2-microglobulin and D-dimer at 6 2 to 72 hours after birth, and simultaneous detection of urinary β-2 microglobulin and cerebrospinal fluid (CSF) neuroenoenolase (NSE). The routine 16-lead EEG test was performed before treatment, 7-10 days after birth, and 3 months after birth. The neurobehavioral development was assessed using Neonatal Neurobehavioral Score (NBNA) and Infant Development Scale (CDCC) respectively. Results The NSE in the treatment group was (18 1 ± 2 1) μg / L and that in the control group was (24 ± 5 3) μg / L (t = 20 4, P 0 05) The 28 dNBNA was (37 ± 2) points and the control group was (32 ± 3) points (t = 1 83, P <0 05). Serum levels of β2 microglobulin, troponin T, D dimer and urinary β2 microglobulin in both groups were significantly increased, but there was no significant difference between the two groups (all P> 0.05). CONCLUSIONS: Preliminary studies have shown that selective head cooling has a neuroprotective effect on term neonatal asphyxia, and it is safe to maintain body temperature above 34 ° C.