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目的探讨不同时间窗治疗新生儿缺氧缺血性脑病(HIE)对神经系统预后的影响,为减少HIE神经系统后遗症的发生提供理论与临床依据。方法回顾性分析131例中度HIE患儿,根据就诊时间分为对照组(生后24～72 h就诊)和试验组(生后24 h内就诊),试验组根据就诊时间分为3个亚组,Ⅰ组(6 h之内),Ⅱ组(6～12 h),Ⅲ组(12～24 h)。每组患儿入院后给予相同的干预治疗,出院后于3、6月龄来我院采用中国标准化的贝来量表(CDCC)测智力发育指数(MDI)和运动发育指数(PDI)。结果对照组32例;试验组99例,其中Ⅰ组33例,Ⅱ组35例,Ⅲ组31例。(1)各组患儿MDI分别为66.9±12.3、79.7±11.4、71.4±10.0、68.0±11.4,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。(2)各组患儿PDI分别为70.8±11.6、83.7±10.6、75.8±11.3、72.4±12.3,Ⅰ组高于对照组、Ⅱ组、Ⅲ组,差异有统计学意义,Ⅱ组、Ⅲ组与对照组之间比较差异无统计学意义。结论不同时间窗开始治疗HIE的预后明显不同,6h内开始治疗的患儿其预后明显优于6h后开始治疗的患儿。提示HIE临床最佳治疗时间窗可能为6h内。
Objective To investigate the effects of different time windows on the prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) and to provide theoretical and clinical evidence to reduce the occurrence of neurological sequelae in HIE. Methods A retrospective analysis of 131 cases of children with moderate HIE, according to the treatment time is divided into control group (24 to 72 h post-treatment) and the experimental group (post-natal 24 h treatment), the experimental group were divided into three sub-sub- Group Ⅰ (within 6 h), group Ⅱ (6 ~ 12 h) and group Ⅲ (12 ~ 24 h). The same intervention was given to each group of children after admission. At 3 and 6 months after discharge, we used the Chinese standardized Beckness scale (CDCC) to measure the mental development index (MDI) and motor development index (PDI). Results The control group of 32 cases; the experimental group of 99 cases, of which 33 cases of group Ⅰ, Ⅱ 35 cases, Ⅲ 31 cases. (1) The MDI of each group were 66.9 ± 12.3, 79.7 ± 11.4, 71.4 ± 10.0 and 68.0 ± 11.4, respectively, which were significantly higher in group Ⅰ than those in control group, group Ⅱ and group Ⅲ, with significant difference between group Ⅱ and group Ⅲ There was no significant difference between the control group and the control group. (2) The PDI in each group was 70.8 ± 11.6, 83.7 ± 10.6, 75.8 ± 11.3 and 72.4 ± 12.3, respectively, and the difference between the two groups was statistically significant There was no significant difference between the control group and the control group. CONCLUSION: The prognosis of HIE beginning at different time windows is obviously different. The prognosis of children who started treatment within 6 hours is obviously better than that of children who started treatment after 6 hours. Tip HIE clinical best treatment time window may be within 6h.