目的 探讨选择性头部亚低温治疗新生儿缺氧缺血性脑病(HIE)不同持续时间对神经系统保护的影响.方法 选择2006年4月至2010年10月佛山市南海区黄岐医院新生儿科收治的中重度HIE患儿,随机分为选择性头部亚低温治疗48 h组、72 h组、96 h组及对照组.对各组患儿生后28天行新生儿20项行为神经测定(NBNA)评分、18月龄时采用贝利婴儿发育量表进行神经行为发育评价,同时监测治疗不良反应、严重伤残例数及死亡例数.结果 共105例患儿完成了治疗和随访,亚低温治疗48 h组、72 h组、96 h组及对照组完成治疗的例数分别为27、26、26及26例.72 h组和96 h组患儿生后28天NBNA评分和18月龄时贝利评分均显著高于48 h组和对照组[NBNA评分:(38.2±5.5)、(37.6±5.7)比(32.5±3.7)、(31.1±3.8),神经发育指数:(98.4±12.5)、(100.1±13.7)比(88.7 ±13.3)、(85.1±10.9),心理运动发育指数:(101.7±15.8)、(99.6±14.1)比(89.2±11.9)、(87.0±13.3),P＜0.05],严重伤残发生率和病死率均低于48 h组和对照组[严重伤残:7.7％、11.5％比22.2％、23.0％,病死率:0、0比11.1％、7.7％,P＜0.05]；而72 h组和96 h组之间、48 h组和对照组之间差异无统计学意义(P＞0.05).96 h组血小板减少、电解质紊乱及血糖异常的发生率高于48 h组和72 h组(P＜0.05),48 h组和72 h组之间差异无统计学意义(P＞0.05).结论 选择性头部亚低温治疗持续72 h对新生儿神经系统近期和远期功能恢复都有明显疗效,明显优于48 h；而延长低温持续时间可能会增加不良反应的发生.%Objective To study the effect of different duration of head-cooling-induced hypothermia on the prognosis of moderate-severe neonatal hypoxic-ischemic encephalopathy.Methods From April 2006 to October 2010,newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE) were randomly assigned into different groups receiving different duration of selective head-cooling hypothermia therapy (i.e.48 h group,72 h group,96 h group and the control group).Behavioral neurological assessment of the newborn (NBNA) were performed on the 28th days after birth,Bayley Infant Development Scale performed at on 18 months,adverse effects,the incidence of severely disabled infants and mortality rate were recorded.Results A total of 105 infants were enrolled 27 in 48 h group,26 in 72 h group,26 in 96 h group,and 26 in the control group.NBNA and Bayley scores in 72 h group and 96 h group were significantly higher than 48 h and control group [NBNA:(38.2 ± 5.5),(37.6 ±5.7)vs.(32.5±3.7),(31.1 ±3.8); MDI:(98.4±12.5),(100.1 ±13.7)vs.(88.7±13.3),(85.1 ±10.9); PDI:(101.7±15.8),(99.6±14.1)vs.(89.2±11.9),(87.0±13.3),P＜0.05],and the incidence of severely disabled infants and mortality rate were lower in 72 h group and 96 h group [incidence of severely disabled:7.7％,11.5％ vs.22.2％,23.0％ ; mortality rate:0,0vs.11.1％,7.7％,P ＜0.05].No significant differences of these indicators were found between 72 h group and 96 h group,48 h group and control group (P ＞ 0.05).The occurrence of thrombocytopenia,electrolyte and glucose imbalance in 96 h group were significantly higher than 48 h group and 72 h group (P ＜ 0.05).Conclusions Selective head-cooling-induced hypothermia therapy lasting for 72 h in the treatment of neonatal HIE could provide short-term and long-term benefits on central nervous system,but more than 72 h only increased the occurrence of adverse effects.
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