高压氧治疗新生儿缺氧缺血性脑病的临床研究

Clinical evaluation of hyperbaric oxygen in treatment of neonatal hypoxic-ischemic Encephalopathy

摘要:

目的探讨高压氧治疗新生儿缺氧缺血性脑病(HIE)的临床疗效及期对预后的影响.方法根据是否进行高压氧治疗随机分为两组,高压氧组203例,对照组98例;两组综合治疗措施相同.高压氧治疗方法是按病情分时期进行.两组分别于生后第2、7、14天做3次行为神经测定(NBNA)以及动态系列各项检测以评价其近期疗效;远期随访至2～5岁的预后转归.结果以总有效率比较,高压氧组疗效明显优于对照组(P＜0.005);高压氧组生后第7、14天的NBNA评分均明显高于对照组(P＜0.05～0.01);生后2个月头颅CT复查比较,高压氧组发生长久性脑损害较对照组明显减少(P＜0.01);以预后不良率比较,高压氧组为9.36%,对照组为25.51%,差异显著(P＜0.01).结论高压氧治疗HIE的近期临床疗效显著,远期预后转归明显改善.按病情分时期进行治疗比较适宜和安全.

Abstract:

Objective: To evaluate the clinical efficacy and prognosis of the hyperbaric oxygen in treatment of neonatal hypoxic-ischemic encephalopathy(HIE). Methods: 301 neonates with HIE were randomly divided into two two groups (treated group 203 neonates, control group 98 neonates), the treated group received hyperbaric oxygen therapeusis at different time based on neonatal conditions. The two groups received 3 times NBNA marks measured (at the 2nd, 7th, 14th day after birth), and other series measured to evaluate short-term efficacy. The two groups were followed up 2~5 years to evaluate their long-term efficacy. Results: The general effective rate of the treated group was significantly higher than that of control group (P<0.05); The NBNA marks of the treated group (at the 7th, 14th day after birth) obviously increased (P<0.05), and long-term brain damage (based on brain CT results of two months) obviously decreased (P<0.01). The unfavorable prognosis rate in treated group (9.36%) was lower than that of control group(25.51%). Conclusion: Hyperbaric oxygen has a markedly short-term therapeutic effect on neonates with HIE and significantly improves the prognosis of the neonates. It is relatively safe and suitable in treating the neonates with HIE at different time based on neonatal conditions.