中重度缺氧缺血性脑病新生儿亚低温治疗诱导期血流动力学的变化探讨

Impact of mild hypothermia therapy on hemodynamics during the induction stage in neonates with moderate to severe hypoxic-ischemic encephalopathy

摘要:

目的 探讨中重度缺氧缺血性脑病（HIE）新生儿在实施全身亚低温治疗诱导低温阶段的血流动力学的变化。方法 选取2017年7月至2020年4月在广东医科大学附属东莞儿童医院新生儿科进行全身亚低温治疗的HIE患儿21例，采用亚低温治疗仪将新生儿直肠温度在1~2 h诱导降至34℃并维持在该水平72 h。期间采用阻抗法进行无创血流动力学监测，分别比较诱导低温开始及达到目标直肠温度（34℃）时患儿的心率（HR）、平均动脉压（MAP）、每搏输出量（SV）、心输出量（CO）、心指数（CI）和总外周阻力（TPR）的变化情况；同步记录血乳酸水平和大脑中动脉阻力指数（RI）。结果 21例HIE患儿平均胎龄（39.6±1.1）周，平均出生体重（3 439±517）g，5 min Apgar评分（6.8±2.0）分。与亚低温前比较，达到目标直肠温度34℃时患儿的HR、CO和CI均明显下降（P < 0.05）；SV和MAP差异无统计学意义（P > 0.05）；TPR明显升高（P < 0.05）；血乳酸水平明显下降（P < 0.05）；RI差异无统计学意义（P > 0.05）。结论 全身亚低温治疗对中重度HIE患儿的血流动力学可产生显著影响，治疗期间需要进行持续的血流动力学监测。

Abstract:

Objective To study the changes in hemodynamics during the induction stage of systemic mild hypothermia therapy in neonates with moderate to severe hypoxic-ischemic encephalopathy(HIE).Methods A total of 21 neonates with HIE who underwent systemic mild hypothermia therapy in the Department of Neonatology,Dongguan Children's Hospital Affiliated to Guangdong Medical University,from July 2017 to April 2020 were enrolled.The rectal temperature of the neonates was lowered to 34℃after 1-2 hours of induction and maintained at this level for 72 hours using a hypothermia blanket.The impedance method was used for noninvasive hemodynamic monitoring,and the changes in heart rate(HR),mean arterial pressure(MAP),stroke volume(SV),cardiac output(CO),cardiac index(CI),and total peripheral resistance(TPR)from the start of hypothermia induction to the achievement of target rectal temperature(34℃).Blood lactic acid(LAC)and resistance index(RI)of the middle cerebral artery were recorded simultaneously.Results The 21 neonates with HIE had a mean gestational age of(39.6±1.1)weeks,a mean birth weight of(3439±517)g,and a mean 5-minute Apgar score of 6.8±2.0.From the start of hypothermia induction to the achievement of target rectal temperature(34℃),there were significant reductions in HR,CO,and CI(P<0.05),while there was no significant change in SV and MAP(P>0.05).There was a significant increase in TPR(P<0.05)and a significant reduction in LAC(P<0.05),while there was no significant change in RI(P>0.05).Conclusions The systemic mild hypothermia therapy may have a significant impact on hemodynamics in neonates with moderate to severe HIE,and continuous hemodynamic monitoring is required during the treatment.