亚低温治疗新生儿缺氧缺血性脑病36例疗效分析及18月龄随访调查被引量：32

Curative effect analysis of mild hypothermia in treatment of neonatal hypoxic-ischemic encephalopathy and follow-up study of 36 children aged 18 months

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摘要目的探讨亚低温（MH）治疗中重度新生儿缺氧缺血性脑病（HIE）的疗效及安全性,并随访出院后18月龄患儿神经运动发育情况.方法选取2007年1月至2013年12月在新生儿重症监护病房（NICU）住院治疗的中重度HIE患儿61例,依据上海市儿童医院NICU购买MH治疗仪前后分为常规治疗组（25例）和MH治疗组（36例）,分别在治疗前、治疗72 h描记振幅整合脑电图（aEEG）,记录出生28 d新生儿20项行为神经测定评分（NBNA）,采用标准化的贝利（Bayley）婴儿发育量表对出院后18月龄患儿进行神经行为发育评价,同时观察MH治疗的不良反应、严重伤残例数及死亡例数.结果 MH治疗组治疗前aEEG与常规治疗组比较差异无统计学意义[最高电压：（22.4±3.1） μV比（18.6±±2.5） μV,最低电压：（8.2±2.6）μV比（6.5±1.9）μV,t=1.264、0.852,P均＞0.05];但治疗72 h描记aEEG比较差异有统计学意义[最高电压：（24.1±3.2）μV比（30.6±2.8） μV,最低电压：（9.7±3.4）μV比（13.3±2.2） μV,t=6.376、4.257,P均＜0.05],MH治疗组严重伤残例数[24.0％（6/25例）比5.6％（2/36例）χ^2=4.405,P＜0.05]及死亡例数[16.0％（4/25例）比0（0/36例）,χ^2 =6.164,P＜0.05]明显下降,出生28 d NBNA[（35.9±±2.1）比（39.1±1.6）,t=3.361,P＜0.05]、随访18月龄标准化的Bayley婴儿发育量表进行神经行为发育评价差异有统计学意义[神经发育指数（MDI）：（85.2±10.7）比（96.5±13.1）,t=7.839,P＜0.05].MH治疗过程中极少数发生呼吸暂停、凝血功能异常及心律失常等不良反应.结论 MH治疗中重度HIE安全有效,可显著降低中重度HIE患儿病死率,改善0～18月龄婴幼儿神经系统发育障碍,明显提高婴幼儿Bayley发育量表神经行为发育评分。 Objective To explore the efficacy and safety of mild hypothermia （MH） in treating the infants with moderate-to-severe neonatal hypoxic-ischemic encephalopathy（HIE）,and to make a follow-up of the nerve motor development of the infants at 18 months old after discharge.Methods Totally 61 neonates with moderate-to-severe HIE in Neonatal Intensive Care Unit （NICU） from Jan.2007 to Dec.2013 were retrospectively analyzed.According to before and after MH therapeutic apparatus was used by NICU of Shanghai Children＇s Hospital,61 neonates of HIE were divided into 2 groups,the conventional treatment group（25 cases） and MH treatment group（36 cases）.The patients in both groups were measured respectively by using the amplitude integrated electroencephalography （aEEG） before MH treatment and at 72 hours after M H treatment,by neonatal behavioral neurological assessment（NBNA） on the 28th day after birth,and by adopting Bayley Scales of Infant Development at 18 months old.The adverse reactions,serious disability cases and deaths of MH treatment were recorded.Results Compared with the conventional treatment group,aEEG recording before treatment showed no statistically significant differences in MH treatment group [maximum voltage：（22.4 ±3.1） μV vs（18.6 ±2.5） μV,maximum voltage：（8.2 ±2.6）μV vs（6.5 ±1.9） μV,t =1.264,0.852,all P 〉 0.05].However,aEEG recording at 72 h after treatment showed statistically significant differences in MH treatment group [maximum voltage：（24.1 ± 3.2） μV vs （30.6 ± 2.8） μV,maximum voltage：（9.7 ± 3.4） μV vs （13.3 ± 2.2） μV,t =6.376,4.257,all P 〈 0.05].Severe disability cases [24.0% （6/25 cases） vs 5.6% （2/36 cases）,χ^2 =4.405,P 〈 0.05] and deaths [16.0% （4/25 cases） vs 0 （0/36 case）,χ^2 =6.1 64,P 〈 0.05] in MH treatment group were significantly decreased,and there was significantly difference in NBNA on the 28th day after birth[（35.9 ± 2.1） vs（39.1-± 1.6）,t =3.361,P 〈 0.05],and scales of