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目的观察选择性头部亚低温治疗在新生儿缺氧缺血性脑病(HIE)中的作用及寻找亚低温治疗的最佳时间窗。方法选取120例符合HIE诊断患儿,随机分为亚低温组和对照组各60例,观察近期疗效和远期疗效。再将亚低温组分为6个小组,每组各10例,比较治疗前和治疗72 h后神经元特异性烯醇化酶(NSE)的情况。结果亚低温组在生后7、14、28 d的新生儿行为神经评分(NBNA评分)比较明显高于对照组(P<0.05);亚低温组在生后6、12个月的智力发育指数(MDI)和精神运动发育指数(PDI)均高于对照组(P<0.05)。亚低温组内6个小组的治疗前和亚低温治疗72 h后,NSE均明显下降(P<0.05),其中第1~4小组治疗前后NSE比较差异较大。结论使用选择性头部亚低温治疗HIE对患儿的近期和远期治疗有明显效果,且在不同时间开始治疗具有差异性,研究表明及早开始行亚低温治疗HIE对预防神经损害效果更佳。
Objective To observe the effect of selective head mild hypothermia on neonatal hypoxic-ischemic encephalopathy (HIE) and find the best time window for treatment of mild hypothermia. Methods A total of 120 children with HIE were selected and randomly divided into mild hypothermia group and control group with 60 cases each. The short-term curative effect and long-term curative effect were observed. Then the mild hypothermia was divided into six groups, 10 in each group. The neuron-specific enolase (NSE) was compared before and 72 h after treatment. Results Neonatal behavioral neurological score (NBNA score) in the mild hypothermia group at 7, 14 and 28 days after birth was significantly higher than that in the control group (P <0.05). The mental development index of the mild hypothermia group at 6 and 12 months after birth (MDI) and psychomotor developmental index (PDI) were higher than those in the control group (P <0.05). NSE in 6 subgroups of hypothermia group before and 72 h after hypothermia treatment decreased significantly (P <0.05), and NSE in groups 1 ~ 4 were significantly different before and after treatment. Conclusions The treatment of HIE with selective head mild hypothermia has obvious effect on the short-term and long-term treatment of children, and the treatment is different at different time points. The study shows that treating hypoxic hypothermia with HIE for a long time can effectively prevent neurological damage.