亚低温对新生儿缺氧缺血性脑病脑组织氧饱和度影响的研究

发布时间：2018-05-08 20:28

本文选题：脑组织氧饱和度 + 亚低温　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:通过研究孕周大于等于36周,患有中度缺氧缺血性脑病的新生儿采用常规治疗及联合头部亚低温治疗在治疗前、治疗中及治疗后的脑组织氧饱和度对比情况,了解新生儿缺氧缺血性脑病患儿在亚低温治疗下与常规治疗相比脑组织氧饱和度的变化,为亚低温治疗新生儿缺氧缺血性脑病有效性提供可能存在的支持依据。方法:选取2015年3月-2016年11月在西南医科大学附属医院新生儿科诊断为中度缺氧缺血性脑病且符合试验要求的95例新生儿为研究对象,据入院时间是否超过6小时分为6小时内组及12小时内组;据家属意愿是否拒绝亚低温分为亚低温治疗组和常规治疗组;故共分为4个试验组,分别为:6小时内亚低温组(A组)37例,6小时内常规治疗组(B组)21例,12小时内亚低温组(C组)18例,12小时内常规组(D组)19例。分别监测四组患儿在治疗前、治疗中及治疗后的脑组织氧饱和度情况;测定四组患儿第4天的aEEG情况;入院2小时内及入院治疗后6-7天抽血完善NSE检验。结果:1、4组新生儿的胎龄、出生体重、性别等的差异均无统计学差异(P0.05)。2、6小时内入院的两组HIE患儿入院时脑组织氧饱和度差异无统计学意义(P0.05);在亚低温治疗时(72小时内)亚低温治疗组的脑氧更低,差异有统计学意义(p0.05);单纯常规治疗组的脑氧在入院后24小时内有上升趋势,可能与缺血“再灌注”损害相关;单纯常规治疗组的脑氧自然下降趋势滞后于亚低温治疗组,且回升缓慢。3、12小时内入院的两组患儿在入院时已经存在“再灌注”损害,但亚低温治疗可以降低脑组织氧耗,改善脑循环及代谢。12小时内入院的两组患儿脑氧在治疗过程中均有下降趋势,但亚低温治疗组的脑氧降低更快更低,脑细胞氧耗降低提示atp能量消耗降低,对脑细胞有更好保护作用;在亚低温治疗期间,亚低温治疗组的脑氧较常规治疗组低,且部分差异有统计学意义;4、不同时间窗亚低温联合常规治疗的aeeg评分均较单纯常规治疗组的评分高,差异有统计学意义,提示亚低温治疗较单纯常规治疗更能改善患儿的预后。5、6小时内入院的hie患儿在亚低温治疗组治疗后的nse值较单纯常规治疗组治疗后的值低,且差异具有统计学意义,提示亚低温治疗组的神经细胞死亡数量更少,能更好的降低脑细胞损害,可能更好地改善患儿的预后;12小时内入院的hie患儿在亚低温治疗后的nse值较单纯常规治疗后的值低,但差异没有统计学意义(p0.05),显示在超过6小时后亚低温治疗是否比单纯常规治疗在减少神经细胞死亡数量方面并不确切,有待继续研究。结论:不同时间窗亚低温均能降低hie脑细胞的氧耗和代谢,对脑细胞具有保护作用,尤其以6小时内行亚低温治疗的疗效更明显,应尽可能早的行亚低温治疗,尽可能的减少“再灌注”损害;近红外光谱测定能无创、实时、床旁监测脑组织氧的情况,为亚低温改善脑组织耗氧情况提供直接有效的依据。联合脑组织氧饱和度、NSE、aEEG能更好的了解HIE患儿的治疗效果及其预后。
[Abstract]:Objective: To study the contrast of brain tissue oxygen saturation in the neonates with moderate hypoxic ischemic encephalopathy after the treatment and combined head mild hypothermia treatment before and after the treatment of moderate hypoxic ischemic encephalopathy, and to understand the comparison of the brain group with the conventional treatment under hypothermia treatment for neonates with hypoxic-ischemic encephalopathy after the treatment of moderate hypoxic ischemic encephalopathy and combined head mild hypothermia treatment. The changes in oxygen saturation provide a possible support basis for the effectiveness of hypothermia for hypoxic ischemic encephalopathy. Methods: 95 newborns, diagnosed as moderate hypoxic ischemic encephalopathy in the newborn Pediatrics Department of the Affiliated Hospital of Southwest Medical University in March 2015 in March 2015, were selected as the research object and were admitted to hospital. Whether the time was more than 6 hours was divided into 6 hours group and 12 hours group; according to whether the family wishes refused subhypothermia into subhypothermia treatment group and routine treatment group, 4 test groups were divided into 6 hours mild hypothermia group (group A) 37 cases, 6 hours routine treatment group (group B) 21 cases, 18 cases of mild hypothermia group (group C) in 12 hours, and often within 12 hours. There were 19 cases in group D. The oxygen saturation of the brain tissue in the four groups was monitored before and after treatment, and the aEEG in four groups of children was measured at fourth days. The NSE test was completed within 2 hours and 6-7 days after admission to the hospital. Results: there was no significant difference in fetal age, birth weight, sex and so on in group 1,4 (P0.05) There was no significant difference in oxygen saturation between the two groups of HIE children admitted to hospital during.2,6 hours (P0.05). The difference was statistically significant (P0.05) in the mild hypothermia treatment group (P0.05). The brain oxygen in the simple treatment group increased in 24 hours after the admission to the hospital, and may be associated with the ischemia "reperfusion". The natural decline of brain oxygen in the simple routine treatment group lags behind the mild hypothermia treatment group, and the two groups of children admitted to the hospital within.3,12 hours of slow recovery have "reperfusion" damage at admission, but mild hypothermia therapy can reduce the oxygen consumption of brain tissue, improve the brain oxygen in the two groups of children hospitalized within the brain circulation and metabolism within.12 hours. There was a downward trend in the treatment process, but the reduction of brain oxygen in the mild hypothermia group was faster and lower, the decrease of oxygen consumption in the brain cells suggested that the energy consumption of ATP decreased and the brain cells had a better protective effect. During the mild hypothermia treatment, the brain oxygen in the mild hypothermia treatment group was lower than that of the conventional treatment group, and the difference was statistically significant; 4, the low time window was low. The AEEG score of temperature combined with conventional treatment was higher than that of the simple routine treatment group. The difference was statistically significant. It suggested that the prognosis of mild hypothermia treatment was better than that of the simple routine treatment. The value of NSE in children with HIE in the sub hypothermia treatment group was lower than that of the Dan Chunchang therapy group at.5,6 hours. The significance of the study suggests that the number of neurons in the mild hypothermia treatment group is less, which can better reduce the brain cell damage, and may better improve the prognosis of the children. The NSE value of the HIE children admitted to the hospital within 12 hours is lower than that after the simple routine treatment, but the difference is not statistically significant (P0.05) after more than 6 hours. Whether mild hypothermia therapy is less precise than simple routine treatment in reducing the number of nerve cells death, it is necessary to continue to study. Conclusion: different time window subhypothermia can reduce oxygen consumption and metabolism of HIE brain cells, and have protective effect on brain cells, especially in the treatment of subhypothermia at 6 hours, which should be as early as possible. Low temperature treatment, as far as possible to reduce the "reperfusion" damage, near infrared spectroscopy can be noninvasive, real-time, monitoring brain tissue oxygen in bed, for subhypothermia to improve the brain tissue oxygen consumption to provide a direct and effective basis. Combined brain tissue oxygen saturation, NSE, aEEG can better understand the treatment effect and prognosis of children with HIE.

【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742

【参考文献】