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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)对血浆非蛋白结合铁(NPBI)及神经行为评分(NBNA)的影响。方法选择2011年1月至2012年6月本院新生儿重症监护病房收治的中、重度HIE患儿。随机分为亚低温组和常规组,分别检测亚低温及常规治疗后0、24、48、72 h及7天血清NPBI浓度,比较两组患儿生后7、14及28天的NBNA评分,以及12个月时后遗症、智力发育指数(MDI)和运动发育指数(PDI)。结果两组患儿治疗开始时NPBI浓度差异无统计学意义(P>0.05),亚低温组在治疗后24、48、72 h血浆NPBI浓度分别为(5.57±0.75)μmol/L、(3.23±0.68)μmol/L、(1.94±0.58)μmol/L,明显低于常规组的(7.40±0.55)μmol/L、(5.53±0.94)μmol/L、(2.70±0.83)μmol/L,差异有统计学意义(P均<0.05)。生后7天两组患儿NBNA评分比较差异无统计学意义(P>0.05),生后14天、28天亚低温组NBNA评分明显高于常规组[14天:(34.0±2.2)比(31.2±2.5),28天:(36.0±1.8)比(34.2±1.5)],差异有统计学意义(P<0.05)。生后12个月,亚低温组患儿MDI及PDI均优于常规组[MDI:(96.2±16.3)比(85.8±8.9),PDI:(88.9±12.6)比(74.3±14.1)],差异有统计学意义(P<0.05);亚低温组后遗症发生率11.8%,常规组后遗症发生率34.4%,差异有统计学意义(P<0.05)。结论 HIE患儿应用选择性头部亚低温治疗后血浆NPBI释放减少,氧化应激损伤减轻,有明显的神经保护作用。
Objective To investigate the effects of selective head mild hypothermia on plasma non-protein bound iron (NPBI) and neurobehavioral score (NBNA) in neonates with hypoxic-ischemic encephalopathy (HIE). Methods From January 2011 to June 2012 in our hospital neonatal intensive care unit admitted to the moderate and severe HIE children. The patients were randomly divided into mild hypothermia group and routine group. The serum NPBI concentrations at 0, 24, 48, 72 and 7 days after hypothermia and routine treatment were respectively detected. The NBNA scores at 7, 14 and 28 days after birth were compared between two groups. And sequelae at 12 months, mental development index (MDI) and motor development index (PDI). Results There was no significant difference in NPBI concentration between the two groups (P> 0.05). The plasma concentrations of NPBI in the mild hypothermia group were (5.57 ± 0.75) μmol / L at 24 h, 48 h and 72 h 0.68 μmol / L and 1.94 ± 0.58 μmol / L, respectively, which were significantly lower than those of the control group (7.40 ± 0.55 μmol / L, 5.53 ± 0.94 μmol / L and 2.70 ± 0.83 μmol / L, Statistical significance (P <0.05). There was no significant difference in NBNA score between the two groups on the 7th day after birth (P> 0.05). The NBNA score of the hypothermia group at 14 days and 28 days after birth was significantly higher than that of the control group [14 days: (34.0 ± 2.2) vs 31.2 ± 2.5), 28 days: (36.0 ± 1.8) vs (34.2 ± 1.5)], the difference was statistically significant (P <0.05). In the 12 months after birth, the MDI and PDI in the mild hypothermia group were significantly higher than those in the conventional group (MDI: (96.2 ± 16.3) vs (85.8 ± 8.9), PDI: (88.9 ± 12.6) vs (74.3 ± 14.1) (P <0.05). The incidence of sequelae in the hypothermia group was 11.8%, the incidence of sequelae in the conventional group was 34.4%, the difference was statistically significant (P <0.05). Conclusions The plasma NPBI release is reduced and the oxidative stress injury is relieved in HIE infants treated with selective head mild hypothermia. It has obvious neuroprotective effect.