亚低温治疗新生儿缺氧缺血性脑病的研究进展

Research progress in mild hypothermia treatment of neonatal hypoxic-ischemic encephalopathy

摘要:

临床随机对照试验已经证实了亚低温治疗新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy, HIE）的安全性和有效性，可降低病死率或严重神经系统后遗症发生率。许多发达国家的NICU已将亚低温作为治疗新生儿HIE的常规方法，我国部分NICU也逐步开展这一疗法，但接受治疗的患儿中仍有40%~50%死亡或伴有严重的神经系统发育异常。哪些病人适合接受亚低温治疗，对这些病人应采取何种降温方式、亚低温治疗的最佳时机、治疗持续的时间、最佳目标温度、亚低温联合其他治疗方法的安全性及远期预后等问题有待进一步探讨，本文将就这些问题的临床研究最新进展做一综述。

Abstract:

Randomized controlled trials have demonstrated the safety and efficacy of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE), which can reduce mortality or the incidence of severe neurological sequelae. Mild hypothermia has been used in the neonatal intensive care unit (NICU) as a routine treatment method for neonatal HIE in many developed countries, and it is increasingly applied in some NICUs in China. However, 40%-50% of the neonates treated with mild hypothermia die or develop severe neurological disability. Thus, to achieve the best neuroprotective effect, issues such as selection of patients with indications for mild hypothermia, cooling method, optimal time for mild hypothermia, duration of mild hypothermia, optimal target temperature, and the safety and long-term effects of mild hypothermia combined with other therapies, need to be further discussed. This article reviews the latest progress in clinical research on these issues.