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目的:比较不同亚低温治疗时间对缺氧缺血性脑病患儿疗效及预后的影响,探讨亚低温治疗的最优时间,并且观察此治疗对新生儿有无不良影响。方法:选取我院收治的80例缺氧缺血性脑病(HIE)新生儿作为研究对象,将患儿随机分亚低温治疗48 h组、72 h组、96 h组和常规治疗组,每组20例患儿。所有患儿均给予常规治疗,亚低温组患儿在上述治疗基础上,在出生后6 h内加用选择性头部亚低温治疗。四组患儿生后28 d时进行神经测定(NBNA)评分,出生18月时进行Bayley评分。患儿接受治疗7天后统计血小板减少、电解质紊乱以及血糖紊乱的发生例数。结果:72 h组和96 h组患儿生后NBNA评分、Bayley评分比48 h组和常规治疗组高(P<0.05),有统计学差异;72 h组和96 h组的NBNA评分、Bayley评分均没有统计学差异(P>0.05),48 h组和常规组的评分也没有统计学差异(P>0.05)。亚低温治疗96 h组患儿中,发生血小板减少、电解质紊乱及血糖紊乱等不良反应的比例较48 h组和72 h组明显增多(P<0.05),有统计学差异;对比48 h组和72 h组不良反应的患儿比例,没有显著统计学差异(P>0.05)。结论:亚低温治疗72 h对HIE患儿的治疗效果优于48 h,产生的副作用小于治疗96 h,建议临床亚低温治疗时间采用72 h以取得最佳治疗效果,产生最小不良反应。
Objective: To compare the effect of different hypothermia treatment time on the efficacy and prognosis of children with hypoxic-ischemic encephalopathy, to explore the optimal time of mild hypothermia, and to observe the treatment of adverse effects on the newborn. Methods: Eighty neonates with hypoxic-ischemic encephalopathy (HIE) were enrolled in this study. The children were randomly assigned to hypothermia treatment for 48 h, 72 h, 96 h and routine treatment groups, each group 20 cases of children. All children were given conventional treatment. Children in mild hypothermia group were treated with selective head mild hypothermia within 6 h after birth. Neurological assessment (NBNA) was performed on the 28th day after birth in the four groups, and Bayley was scored at 18 months of age. The number of children with thrombocytopenia, electrolytes and blood sugar disorders counted after 7 days of treatment. Results: The postnatal NBNA score and Bayley score of 72 h group and 96 h group were higher than those of 48 h and conventional treatment group (P <0.05), and there was significant difference between the two groups. The NBNA score of 72 h and 96 h group, Bayley There was no significant difference between the two groups (P> 0.05). There was no significant difference between the 48 h group and the control group (P> 0.05). Compared with 48 h group and 72 h group, the percentage of adverse reactions such as thrombocytopenia, electrolyte disturbance and blood glucose disorder in mild hypothermia group was significantly higher than that in 48 h group (P <0.05) There was no significant difference in the proportion of children with adverse reactions in 72 h group (P> 0.05). Conclusion: The treatment effect of mild hypothermia for 72 h in children with HIE is better than 48 h, and the side effects are less than 96 h. It is suggested that the treatment time of mild hypothermia should be 72 h to obtain the best therapeutic effect with minimal adverse reactions.