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目的 探讨新生儿缺氧缺血性脑病 (HIE)的发生率及早期诊断。方法 选择大连市妇产医院 2 0 0 1年出生的活产窒息新生儿作观察对象 ,调查HIE发生率。抽取其中 30 5例足月窒息儿 ,于出生后 72h内按时段严密观察其神经系统症状及体征共 18项 ,比较确诊HIE病例与未被确诊HIE病例 18项指标的变化及出现频率。结果 大连市妇产医院 2 0 0 1年出生活产新生儿 82 78例 ,足月儿 7899例 ,早产儿 379例 ;发生窒息 4 81例 ,诊断HIE 79例 (79/ 82 78,0 95 % )。 30 5例足月窒息儿中 ,经观察至 72h ,5 5例诊断为HIE ,余 2 5 0例为单纯窒息儿 ;HIE患儿生后兴奋、激惹发生率为 6 1 8% ,持续 2 4h者仍占 32 7% ,窒息儿少见的嗜睡、迟钝发生率为 18 2 % ,生后肢体肌张力减弱和拥抱、握持反射减弱发生率在 6 0 %以上 ,生后 72h仍持续在 4 0 % ;两组患儿在各时段神经症状出现频率比较 :生后 30min兴奋、激惹发生率两组差异最大 (P <0 0 1)。结论 HIE发生率占新生儿总数的0 95 % ,占足月儿 1 0 0 % ,占窒息儿的 16 4 2 %。HIE患儿最早出现的神经系统症状是兴奋、激惹意识改变 ;3～6h时仍有肢体肌张力改变 ,部分可出现嗜睡、抑制症状 ,此时可考虑HIE诊断 ;生后 12h ,窒息儿兴奋、激惹已明显减少 ,肢体肌张力也基本恢复
Objective To investigate the incidence and early diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods Select live births asphyxia newborn born in 2001 in maternity and obstetrics hospital of Dalian as observation object and investigate the incidence of HIE. A total of 30 5 cases of full-term asphyxia were selected and 18 neurological symptoms and signs were observed closely within a time period of 72 hours after birth. The changes and frequency of 18 indicators of HIE cases and those without HIE were compared. Results 82 78 newborns, 7899 full-term infants and 379 premature infants were born in Dalian Maternity Hospital in 2001. There were 4 81 cases of asphyxia and 79 cases of 78 785 95% ). Among 755 full-term asphyxial infants, 55 cases were diagnosed as HIE after 72 hours of observation, and 250 cases were asphyxiated alone. The incidence of excitement and excitement in HIE children after birth was 61.8% for 2 4h still accounted for 32 7%, asphyxia rare drowsiness, the incidence of retardation was 18 2%, post-natal limb weakness and embrace, decreased reflex grasping the incidence of more than 6 0% 72h after birth still continued at 4 0%. The frequency of neurological symptoms in two groups was significantly different between the two groups at 30 minutes after birth (P <0.01). Conclusions The incidence of HIE accounts for 0 95% of the total number of newborns, accounting for 100% of full-term children and 16 4 2% of those with asphyxia. HIE in children with the first symptoms of nervous system is excited, irritable changes in consciousness; 3 ~ 6h still limb muscle tone changes, some may appear lethargy, inhibition of symptoms, this time can be considered HIE diagnosis; 12h after birth, suffocation excited , Irritation has been significantly reduced, limb muscle tension also recovered