摘要
目的:观察早期应用高压氧干预后缺氧缺血性脑病新生儿行为神经评分及对1年后智能发育商的变化。方法:选择2002-01/2004-03收治于廉江市人民医院儿科窒息合并缺氧缺血性脑病新生儿80例。随机分为2组,常规药物组40例和高压氧早期干预组40例。常规药物组严格按照儿科治疗手册中常规3项支持疗法和3项对症处理进行早期治疗,高压氧早期干预组同时早期给予高压氧l治疗。高压氧舱为上海701所研制的SHC-1800小型氧舱,给予一级吸氧,治疗压力为0.08MPa,升压30min,减压30min,稳压40min,中间休息1次,合计100min,1次/d,10～14d为1个疗程,可治疗2～3个疗程。采用中国新生儿20项行为神经评分法,对所有患儿分别于治疗前、治疗1个疗程后各测定1次行为神经评分(满分为40分,<35分为异常)。随访1年,采用Gesell初评方法测试其动作能、应物能、应人能、言语能等4个能区的智能发育商。结果:80例患儿均完全接受了1个疗程的治疗,高压氧早期干预组中有6例继续进行2～3个疗程的治疗。两组治疗后随访1年,各有2例失访,随访率为95%。①治疗前后两组行为神经评分≥35的例数比较:高压氧早期干预组高于常规治疗组[治疗前(17,18例),治疗后(35,27例),χ2=4.59,P<0.05];治疗后行为神经评分高于常规药物组(38.6±2.4,33.8±2.4,P<0.01)。②随访1年后智能发育商得分:高压氧早期干预组治疗后动作能评分较常规药物组明显提高(106.7±10.2,89.7±11.2,P<0.01);应物能明显提高(102.3±12.06,87.7±12.2,P<0.01);应人能明显提高(105.7±11.5,90.3±11.5,P<0.05);言语能提高(99.7±12.0,94.4±10.2,P<0.05)。结论:高压氧早期干预治疗能提高缺氧缺血性脑病新生儿的行为神经评分及1年后智能发育商。高压氧可提高血氧分压、加大氧弥散半径、改善组织有氧代谢及组织微循环,有利于脑组织的存活和受损神经细胞的修复,可明显改善患儿的预后。
AIM: To observe the changes of neonatal behavior neurological assessment (NBNA) and one year intellectual development quotient in newborn with hypoxic-ischemic encephalopathy after early intervention of high pressure oxygen . METHODS: Eighty newborns with apnea combined with hypoxic ischemic encephalopathy receiving treatment in Department of Pediatrics in Lianjiang People's Hospital were selected from January 2002 to March 2004 and divided randomly into 2 groups: routine drug group and high pressure oxygen treatment group with 40 cases in each group.Newborns in routine drug group received three routine supporting therapies and three symptomatic treatments according to pediatrics therapy manual. Newborns in high pressure oxygen treatment group received high pressure oxygen treatment on the basis of routine treatment mentioned above.Hyperbaric oxygen chamber SHC-1800 mini-oxygen chamber were produced by Shanghai 701 Institute, giving first grade oxygen with 0.08 MPa therapy pressure, increasing pressure 30 minutes, decreasing pressure 30 minutes, and steadying pressure 40 minutes with once rest in the middle, totally 100 minutes, once per day, 10 to 14 days as one courses, for 2 to 3 course. Using Chinese 20 terms NBNA method, all patients were tested once before treatment and after 1 course treatment (full mark: 40 points, less than 35: abnormal). After one-year lollow-up,Gesell preliminary assessment method was used to test their four kinds of intellectual development quotients, including action ability; responsible object ability, responsible human ability, and language ability etc. RESULTS: Totally 80 children patients received one course treatment. Six patients in high pressure oxygen treatment group continuously received 2 to 3 course treatment. After treatment patients in the two groups were followed for 1 year, with 2 patients lost to follow-up and follow-up rate was 95%. ① The number comparison between the two groups of behavior nerve score over 35 pre-and post-treatment: It was higher in high pressure oxygen treatment group than that in routine treatment group [pre-treatment(17,18 cases),post-treatment(35,27 cases),(χ2=4.59,P < 0.05)]; After treatment behavior nerve score was higher than that in routine drug group (38.6±2.4,33.8±2.4, P < 0.01).② The score of intellectual development quotient after one year follow-up: The score of action ability in high pressure oxygen treatment group after treatment was higher significantly than that in routine drug group (106.7±10.2,89.7±11.2,P < 0.01);Responsible object ability increased significantly (102.3±12.06,87.7±12.2,P< 0.01);Responsible people ability increased significantly (105.7±11.5,90.3±11.5,P < 0.05);Language ability increase significantly (99.7±12.0,94.4±10.2,P < 0.05). CONCLUSION: Early intervention of high pressure oxygen can raise the socre on NBNA and intellectual development quotient after one year in neonate with hypoxic ischemic encephalopathy. High pressure oxygen can raise the partial pressure between blood and oxygen, increase oxygen diffusion radius, improve tissue aerobics and tissue microcirculation, ameliorate the prognosis of children patients and is beneficialto the survival of brain tissue and the repair of injured nerve cells.
出处
《中国临床康复》
CSCD
北大核心
2005年第23期194-195,共2页
Chinese Journal of Clinical Rehabilitation
