促红细胞生成素结合高压氧对缺氧缺血性脑病患儿神经功能恢复和脑组织代谢的影响
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篇名: 促红细胞生成素结合高压氧对缺氧缺血性脑病患儿神经功能恢复和脑组织代谢的影响
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摘要: 目的:探讨促红细胞生成素结合高压氧对缺氧缺血性脑病(HIE)患儿神经功能恢复和脑组织代谢的影响。方法:选择2012年9月-2015年4月我院HIE患儿47例,按照随机数字表法分为观察组(25例)和对照组(22例)。两组患儿均给予降颅内压、纠正酸中毒、维持电解质平衡和控制惊厥等常规的对症支持治疗。对照组患儿给予高压氧治疗,加压15 min,吸氧30 min,减压15 min,qd;观察组患儿在对照组基础上给予重组人促红素注射液(CHO细胞)200 U/kg,首次为皮下注射,第2次起为静脉推注,qd。两组患儿均连续治疗10 d。观察两组患儿治疗前后的新生儿神经行为测定(NBNA)评分、神经反射恢复时间、意识恢复时间和血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、S100B蛋白水平,并记录不良反应发生情况。 结果:治疗前,两组患儿NBNA评分和血清NSE、MBP、S100B蛋白水平比较,差异均无统计学意义(P>0.05)。治疗后5、10 d,两组患儿NBNA评分较治疗前均明显升高,且观察组明显高于对照组同期水平,差异均有统计学意义(P<0.05);两组患儿血清NSE和S100B蛋白水平较治疗前均明显降低,且观察组明显低于对照组同期水平,差异均有统计学意义(P<0.05)。治疗后5 d,两组患儿血清MBP水平较治疗前明显升高,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05);治疗后10 d,两组患儿血清MBP水平较治疗前明显降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患儿神经反射恢复时间和意识恢复时间均明显短于对照组,差异有统计学意义(P<0.05)。观察组患儿不良反应发生率(8.00%)与对照组(9.09%)比较,差异无统计学意义(P>0.05)。结论:促红细胞生成素结合高压氧治疗HIE,能有效促进患儿神经功能恢复,改善脑组织代谢,且安全性较高。
ABSTRACT: OBJECTIVE: To investigate the effects of erythropoietin (EPO) combined with hyperbaric oxygen on neurologic function recovery and cerebral tissue metabolism of hypoxic-ischemic encephalopathy (HIE). METHODS: A total of 47 HIE neonates in our hospital during Sept. 2012-Apr. 2015 were selected and divided into observation group (25 cases) and control group (22 cases) according to random number table. Both groups received routine symptomatic supportive treatment as reducing intracranial pressure, correcting acidosis, maintaining electrolyte balance and controlling seizures. Control group was given hyperbaric oxygen therapy, compressing 15 min, inhaling 30 min, decompressing 15 min, qd. Observation group was additionally given rhEPO injection (CHO cell) 200 U/kg, subcutaneously at the first time, intravenous injection from the second time, qd. Both groups were treated for consecutive 10 d. NBNA score, neural reflex recovery time, consciousness recovery time, the serum levels of NSE, MBP and S100B protein were observed in 2 groups before and after treatment. The occurrence of ADR was recorded. RESULTS: Before treatment, there was no statistical significance in NBNA score, serum levels of NSE, MBP and S100B protein between 2 groups (P>0.05). Five and ten days after treatment, NBNA scores of 2 groups were increased significantly compared to before treatment, and the observation group was significantly higher than the control group at corresponding period, with statistical significance (P<0.05). The serum levels of NSE and S100B protein in 2 groups were decreased significantly compared to before treatment, and the observation group was significantly lower than control group at corresponding period, with statistical significance (P<0.05). After 5 days of treatment, serum levels of MBP in 2 groups were increased significantly compared to before treatment, with statistical significance (P<0.05), but there was no statistical significance between 2 groups (P>0.05). After 10 days of treatment, serum levels of MBP in 2 groups were decreased significantly, and the observation group was significantly lower than control group, with statistical significance (P<0.05). After treatment, neural reflex recovery time and consciousness recovery time of observation group were significantly shorter than control group, with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between observation group (8.00%)  and control group (9.09%) (P>0.05).  CONCLUSIONS: For HIE neonates, EPO combined with hyperbaric oxygen can effectively promote neurologic function recovery and cerebral tissue metabolism with good safety.
期刊: 2017年第28卷第17期
作者: 王进,霍颖浩,万永占
AUTHORS: WANG Jin,HUO Yinghao,WAN Yongzhan
关键字: 促红细胞生成素;高压氧;新生儿;缺氧缺血性脑病;神经功能;脑组织代谢
KEYWORDS: Erythropoietin; Hyperbaric oxygen; Neonate; Hypoxic-ischemic encephalopathy; Neurologic function; Cerebral tissue metabolism
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