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目的 研究亚低温治疗新生儿窒息后缺氧缺血脑损伤 (hypoxic ischem ic brain dam age,HIBD)的安全性。 方法 1999年 7月~ 2 0 0 0年 7月本院 NICU收治的 2 4例中重度窒息足月新生儿 ,出生体重 (32 0 0± 6 0 0 ) g,Apgar评分 5 min<5分 ;生后 6 h内存在脑电图异常和 (或 )临床神经系统症状和体征 ,分为治疗组 (11例 )和对照组 (13例 )。治疗组采用选择性头部降温方法 ,维持鼻咽温度为 (34 .0 0± 0 .2 0 )℃ ,持续 72 h;对照组不进行亚低温治疗。新生儿生后 6 2~ 72 h采血检测肌钙蛋白T、肌酐、尿素氮、β2 微球蛋白、肝功能、出凝血时间、D-二聚体 ,同时检测尿 β2 微球蛋白等。 结果 治疗组患儿未发生硬肿、呼吸暂停、心律失常、低血钾、低血钠等 ,两组患儿血 β2 微球蛋白、肌钙蛋白 T、D-二聚体 ,以及尿 β2 微球蛋白明显升高 ,两组差异无显著性 (P均 >0 .0 5 )。 结论 采用选择性头部降温方法治疗新生儿 HIBD是可行的 ,将体温维持在 34 .5℃左右 ,对窒息新生儿的心、肾、肝、凝血及代谢功能无不良影响 ,故该温度对于窒息新生儿是安全的
Objective To study the safety of mild hypothermia in the treatment of neonatal hypoxic ischemic brain injury (HIBD) after asphyxia. Methods From July 1999 to July 2000, 24 neonates with moderate or severe asphyxia were admitted to the NICU in our hospital. The birth weight (32 000 ± 600) g and Apgar score of 5 min were less than 5. There were EEG abnormalities and / or clinical neurological symptoms and signs within 6 h after birth, which were divided into treatment group (n = 11) and control group (n = 13). In the treatment group, selective head cooling was used to maintain the nasopharyngeal temperature at (34.0 ± 0.2) ° C for 72 h. The control group was not treated with mild hypothermia. Twenty-two to 72 h postnatal neonatal blood was collected for detection of troponin T, creatinine, urea nitrogen, β 2 microglobulin, liver function, clotting time, D-dimer, and urine β2 microglobulin. Results There was no swelling, apnea, arrhythmia, hypokalemia and hyponatremia in the treatment group. Serum β2 microglobulin, troponin T, D-dimer and urinary β2 microglobulin Globulin was significantly increased, no significant difference between the two groups (P all> 0.05). Conclusion It is feasible to treat HIBD in neonates by selective head cooling method. The maintenance of body temperature at about 34.5 ℃ has no adverse effect on heart, kidney, liver, blood coagulation and metabolism of asphyxiated neonates, Neonatal is safe