2021 年第 9 期 第 16 卷

促红细胞生成素联合亚低温治疗中重度新生儿缺氧缺血性脑病的疗效评价

Curative effect of erythropoietin combined with mild hypothermia therapy on moderate and severe neonatal hypoxic-ischemic encephalopathy

作者：赵芳萍石静云李修晶刘东海谈笑

英文作者：Zhao Fangping Shi Jingyun Li Xiujing Liu Donghai Tan Xiao

单位：甘肃省妇幼保健院新生儿重症监护中心，兰州730050

英文单位：Neonatal Intensive Care Center Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050 China

关键词：新生儿缺氧缺血性脑病；亚低温治疗；促红细胞生成素；超氧化物歧化酶；头颅磁共振成像

英文关键词：Neonatalhypoxic-ischemicencephalopathy;Mildhypothermia;Erythropoietin;Superoxidedismutase;Cranialmagneticresonanceimaging

• 摘要：

• 目的 探讨促红细胞生成素(EPO)联合亚低温治疗中重度新生儿缺氧缺血性脑病(NHIE)的疗效。方法 选取2017年3月至2019年7月于甘肃省妇幼保健院住院治疗的92例中重度NHIE患儿，根据随机数字表法分为观察组和对照组，各46例。所有患儿均接受亚低温治疗72 h，观察组予重组人促红素注射液静脉滴注，对照组予0.9%氯化钠注射液静脉滴注，均治疗14 d。记录2组基线资料，比较2组出生后24、72、168 h血清超氧化物歧化酶(SOD)水平。治疗14 d后行头颅磁共振成像（MRI）检查，计算并比较2组改良的Barkovich评分。结果 2组胎龄、体质量、男性比例、1 min Apgar评分、惊厥比例、自然分娩比例比较，差异均无统计学意义（均P＞0.05）。观察组出生后24、72、168 h 血清SOD水平逐渐降低［（232±141）、（174±84）、（124±28）kU/L］，且观察组出生后72、168 h 血清SOD水平均低于对照组［（247±103）、（189±66）kU/L］，差异均有统计学意义（t=3.708、6.153，均P＜0.001）。治疗14 d后观察组18例、对照组21例患儿头颅MRI异常。头颅MRI异常患儿中，观察组改良的Barkovich评分低于对照组［（2.0±1.3）分比（4.0±1.7）分］，差异有统计学意义（t=4.014，P＜0.001）。结论 EPO联合亚低温治疗中重度NHIE能进一步减轻神经系统损伤，改善预后。

• Objective To investigate the curative efficacy of erythropoietin combined with mild hypothermia therapy on moderate and severe neonatal hypoxic-ischemic encephalopathy(NHIE). Methods From March 2017 to July 2019, 92 neonatus with moderate and severe NHIE hospitalized in Gansu Provincial Maternity and Child-care Hospital were enrolled. They were randomly divided into observation group and control group, with 46 cases in each group. All neonatus were given mild hypothermia therapy for 72 h. The observation group was given recombinant human erythropoietin injection for intravenous infusion, and the control group was given 0.9% sodium chloride injection for intravenous infusion. Both groups were treated for 14 d. The baseline data of the two groups were recorded. Levels of serum superoxide dismutase(SOD) at 24, 72 and 168 h after birth were compared between the two groups. After 14 d of treatment, the cranial magnetic resonance imaging (MRI) was finished, and modified Barkovich score was calculated and compared between the two groups. Results There were no significant differences in gestational age, body mass, male rate, 1 min Apgar score, convulsions rate and spontaneous delivery rate(all P>0.05). The serum SOD level in the observation group gradually decreased at 24, 72 and 168 h after birth［（232±141）,（174±84）,（124±28）kU/L］, and that in the observation group at 72 and 168 h was lower than that in the control group［（247±103）,（189±66）kU/L］(t=3.708, 6.153, both P<0.001). After 14 d of treatment, there were 18 cases with abnormal cranial MRI in the observation group and 21 cases with that in the control group. Among those abnormal cranial MRI cases, the modified Barkovich score in the observation group was lower than that in the control group［（2.0±1.3） vs （4.0±1.7）］（t=4.014， P＜0.001）. Conclusion Erythropoietin combined with mild hypothermia therapy in moderate and severe NHIE can further reduce the nervous system injury and improve prognosis.