【摘要】 目的 研究新生儿缺氧缺血脑损伤的亚低温临床实施方法。方法 对1999年7月～2000年3月,上海医科大学附属儿科医院新生儿监护病房收治出生体重为(3.42±0.56)kg,Apgar评分5min<5,生后6h内存在脑电图异常和/或临床神经系统症状和体征的11例足月重度窒息新生儿,选择性头部降温,维持鼻咽温度为(34±0.2)℃,持续72h,动态24h心肺功能及呼吸暂停、血气分析、血糖、血电解质等监测。结果 选择性头部降温将鼻咽温度下降至34℃所需时间为(45±25)min。亚低温治疗后复温至35.5℃所需时间为(450±175)min。降温初期鼻咽-直肠温差为1.5℃,降温至72h鼻咽-直肠温差为0.5℃。亚低温实施过程中,无硬肿、呼吸暂停、心律失常、抽搐、低血压、DIC等发生。治疗24、28、72h患儿心率低于治疗前,差异有显著性,治疗24、48h血钙水平低于治疗前,差异有显著性,呼吸、收缩压、舒张压、平均压、血糖、Na~+、K~+与治疗前比较差异无显著性,但治疗中存在代谢性酸中毒。结论 选择性头部降温方法在新生儿亚低温治疗中是可行的。更多还原

【Abstract】 Objective To study the method of hypothermia in neonates with hypoxic-ischemic brain damage after birth asphyxia. Methods After patiental approval,eleven newborns of≥37 weeks’ gestation, who had Apgar≤5 at 5 minutes, plus evidence of encephalopathy and/or abnormal EEG during 4 to 6 hours after birth were selected as subjects. Circulating water of selective head cooling cap were adjusted to maintain the nasopharyngeal temperature at about 34. 0 ±0. 2C for 72 hours. All infants had continuous electrocardiograph, respiratory function, blood gas and blood pressure monitoring as indicated. Results The nasopharyngeal temperature of patients was 1. 5 C lower than the rectal temperature during cooling and 0. 5 C lower when cooling had ceased. We found significant decrease in heart rates and blood calcium and metabolic acidosis. There were no significant differences in respiratory rates, blood pressure and blood glucose. Conclusions The results suggested that the selective head cooling were practical and the adverse effect were slight.更多还原