本文選題：腦組織氧飽和度 + 亞低溫　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過研究孕周大于等于36周,患有中度缺氧缺血性腦病的新生兒采用常規(guī)治療及聯(lián)合頭部亞低溫治療在治療前、治療中及治療后的腦組織氧飽和度對(duì)比情況,了解新生兒缺氧缺血性腦病患兒在亞低溫治療下與常規(guī)治療相比腦組織氧飽和度的變化,為亞低溫治療新生兒缺氧缺血性腦病有效性提供可能存在的支持依據(jù)。方法:選取2015年3月-2016年11月在西南醫(yī)科大學(xué)附屬醫(yī)院新生兒科診斷為中度缺氧缺血性腦病且符合試驗(yàn)要求的95例新生兒為研究對(duì)象,據(jù)入院時(shí)間是否超過6小時(shí)分為6小時(shí)內(nèi)組及12小時(shí)內(nèi)組;據(jù)家屬意愿是否拒絕亞低溫分為亞低溫治療組和常規(guī)治療組;故共分為4個(gè)試驗(yàn)組,分別為:6小時(shí)內(nèi)亞低溫組(A組)37例,6小時(shí)內(nèi)常規(guī)治療組(B組)21例,12小時(shí)內(nèi)亞低溫組(C組)18例,12小時(shí)內(nèi)常規(guī)組(D組)19例。分別監(jiān)測(cè)四組患兒在治療前、治療中及治療后的腦組織氧飽和度情況;測(cè)定四組患兒第4天的aEEG情況;入院2小時(shí)內(nèi)及入院治療后6-7天抽血完善NSE檢驗(yàn)。結(jié)果:1、4組新生兒的胎齡、出生體重、性別等的差異均無統(tǒng)計(jì)學(xué)差異(P0.05)。2、6小時(shí)內(nèi)入院的兩組HIE患兒入院時(shí)腦組織氧飽和度差異無統(tǒng)計(jì)學(xué)意義(P0.05);在亞低溫治療時(shí)(72小時(shí)內(nèi))亞低溫治療組的腦氧更低,差異有統(tǒng)計(jì)學(xué)意義(p0.05);單純常規(guī)治療組的腦氧在入院后24小時(shí)內(nèi)有上升趨勢(shì),可能與缺血“再灌注”損害相關(guān);單純常規(guī)治療組的腦氧自然下降趨勢(shì)滯后于亞低溫治療組,且回升緩慢。3、12小時(shí)內(nèi)入院的兩組患兒在入院時(shí)已經(jīng)存在“再灌注”損害,但亞低溫治療可以降低腦組織氧耗,改善腦循環(huán)及代謝。12小時(shí)內(nèi)入院的兩組患兒腦氧在治療過程中均有下降趨勢(shì),但亞低溫治療組的腦氧降低更快更低,腦細(xì)胞氧耗降低提示atp能量消耗降低,對(duì)腦細(xì)胞有更好保護(hù)作用;在亞低溫治療期間,亞低溫治療組的腦氧較常規(guī)治療組低,且部分差異有統(tǒng)計(jì)學(xué)意義;4、不同時(shí)間窗亞低溫聯(lián)合常規(guī)治療的aeeg評(píng)分均較單純常規(guī)治療組的評(píng)分高,差異有統(tǒng)計(jì)學(xué)意義,提示亞低溫治療較單純常規(guī)治療更能改善患兒的預(yù)后。5、6小時(shí)內(nèi)入院的hie患兒在亞低溫治療組治療后的nse值較單純常規(guī)治療組治療后的值低,且差異具有統(tǒng)計(jì)學(xué)意義,提示亞低溫治療組的神經(jīng)細(xì)胞死亡數(shù)量更少,能更好的降低腦細(xì)胞損害,可能更好地改善患兒的預(yù)后;12小時(shí)內(nèi)入院的hie患兒在亞低溫治療后的nse值較單純常規(guī)治療后的值低,但差異沒有統(tǒng)計(jì)學(xué)意義(p0.05),顯示在超過6小時(shí)后亞低溫治療是否比單純常規(guī)治療在減少神經(jīng)細(xì)胞死亡數(shù)量方面并不確切,有待繼續(xù)研究。結(jié)論:不同時(shí)間窗亞低溫均能降低hie腦細(xì)胞的氧耗和代謝,對(duì)腦細(xì)胞具有保護(hù)作用,尤其以6小時(shí)內(nèi)行亞低溫治療的療效更明顯,應(yīng)盡可能早的行亞低溫治療,盡可能的減少“再灌注”損害;近紅外光譜測(cè)定能無創(chuàng)、實(shí)時(shí)、床旁監(jiān)測(cè)腦組織氧的情況,為亞低溫改善腦組織耗氧情況提供直接有效的依據(jù)。聯(lián)合腦組織氧飽和度、NSE、aEEG能更好的了解HIE患兒的治療效果及其預(yù)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.

【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742

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