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目的：比较不同亚低温治疗时间对缺氧缺血性脑病患儿疗效及预后的影响，探讨亚低温治疗的最优时间，并且观察此治疗对新生儿有无不良影响。方法：选取我院收治的80 例缺氧缺血性脑病（HIE）新生儿作为研究对象，将患儿随机分亚低温治疗48 h 组、72 h组、96 h组和常规治疗组，每组20 例患儿。所有患儿均给予常规治疗，亚低温组患儿在上述治疗基础上，在出生后6 h内加用选择性头部亚低温治疗。四组患儿生后28 d时进行神经测定（NBNA）评分，出生18 月时进行Bayley评分。患儿接受治疗7 天后统计血小板减少、电解质紊乱以及血糖紊乱的发生例数。结果：72 h组和96 h组患儿生后NBNA评分、Bayley评分比48 h组和常规治疗组高（P＜0.05），有统计学差异；72 h组和96 h组的NBNA 评分、Bayley评分均没有统计学差异（P＞0.05），48 h组和常规组的评分也没有统计学差异（P＞0.05）。亚低温治疗96 h组患儿中，发生血小板减少、电解质紊乱及血糖紊乱等不良反应的比例较48 h组和72 h组明显增多(P＜0.05)，有统计学差异；对比48 h组和72 h组不良反应的患儿比例，没有显著统计学差异 (P＞0.05)。结论：亚低温治疗72 h对HIE 患儿的治疗效果优于48 h，产生的副作用小于治疗96 h，建议临床亚低温治疗时间采用 72 h以取得最佳治疗效果，产生最小不良反应。

英文摘要:

Objective:To explore the influence of different therapeutic hypothermia time on curative effect and prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) and its adverse effects, and find the optimal time of therapeutic hypothermia.Methods:Eighty cases of HIE in our hospital were selected as the object of study. The neonates were randomly divided into 48 h group, 72 h group, 96 h group of the hypothermia treatment and routine treatment group, each group of 20 cases. All patients were given conventional treatment, and the patients in mild hypothermia group of different time were treated with selective head sub hypothermia after the birth of 6 h on the basis of the above treatment. The NBNA score of 28 d after birth, Bayley score at 18 months was detected. After 7 days of treatment, the case number of thrombocytopenia, electrolyte disturbance and disorder of the blood glucose was recorded.Results:NBNA score, Bayley score in 72 h group and 96 h group more than that of the 48 h group and routine treatment group, there was significant difference (P<0.05), but no statistically significant differences was detectable between 72 h group and 96 h group (P>0.05), and between 48 h group and routine group (P>0.05). The adverse reaction of thrombocytopenia, electrolyte imbalance and disorder of blood glucose was significantly higher in 96 h group of mild hypothermia treatment than that of 48 h group and 72 h group with significant difference (P<0. 05),but no statistical significance was detected between 48 h group and 72 h group (P>0.05).Conclusion:For the curative effect of HIE neonates, mild hypothermia treatment for 72 h was superior to the treatment for 48 h, and its side effects were less than treatment for 96 h, suggesting that 72 h should be the optimal time for the mild hypothermia treatment to achieve good effect and minimal adverse effects.

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