目的：探讨纳洛酮、肝素和复方丹参注射液等联合早期干预对围生期重度窒息新生儿脑损伤程度的影响。方法：180例重度窒息复苏后的新生儿随机分为4组：常规治疗组(A组)45例，即在对症支持处理的基础上使用脑活素和胞二磷胆碱治疗；纳洛酮治疗组(B组)45例，在常规治疗基础上加用纳洛酮；丹参治疗组(C组)45例，在常规治疗基础上加用复方丹参注射液治疗；多药联合治疗组(D组)45例，在常规治疗的基础上尽早(生后6 h内)应用纳洛酮、肝素和复方丹参注射液等联合治疗。观察和比较各组惊厥的发生和病死率，缺氧缺血性脑病(HIE)的临床分度和行为神经评分测定。结果：D组与A组或B，C组比较，前者的惊厥及重度HIE的发生率均明显低于后者(惊厥发生率A，B，C，D组分别为 66.7%，44.4%，53.3%，35.6%，P<0.05；重度HIE发生率A，B，C，D组分别为 53.3%，37.8%，42.2%，26.7%，P<0.05)。生后7～8 d和12～14 d行为神经评分<35分者所占百分比前者亦明显低于后者(生后7～8 d A，B，C，D组分别为 74.3%，50.0%，47.5%，25.6%，P<0.05；生后12～14 d分别为 57.1%，35.0%，32.5%，14.0%，P<0.05)，前者的病死率亦较低。结论：对围生期重度窒息的新生儿，在对症支持治疗基础上尽早使用纳洛酮、肝素和复方丹参注射液等，能显著减轻缺氧缺血性脑损伤程度。

OBJECTIVE: To investigate the effect of early intervention with naloxone, heparin and radix salviae miltrorrhizae (a Chinese patent medicine improving blood circulation) on brain damage in the newborn following severe perinatal asphyxia. METHODS: One hundred and eighty neonates with severe perinatal asphyxia were randomly assigned into four groups (45 cases each group): Group A received routine treatment (using cerebrolysin and citicoline); besides routine treatment, Group B, Group C and Group D were given naloxone, radix salviae miltrorrhizae and the combination of naloxone, heparin and radix salviae miltrorrhizae, respectively. The incidence of convulsion and the mortality were observed; the degree of hypoxic ischemic encephalopathy (HIE) was evaluated; and the Neonatal Behavioral Neurological Assessment (NBNA) was done in all groups. RESULTS: The incidence of convulsion and severe HIE was significantly lower ( 35.6% and 26.7% ) in Group D compared with that of Group A, B or C ( 66.7% , 44.4% , 53.3% ; 53.3% , 37.8% , 42.2% )(P< 0.05 ). The percentage of the cases whose NBNA marks were less than 35 at 7-8 d ( 25.6% ) and 12-14 d ( 14.0% ) after birth in Group D was much lower than that in Group A, B or C ( 74.3% , 50.0% , 47.5% ; 57.1% , 35.0% , 32.5% )(P< 0.05 ). The mortality of Group D was also lower. CONCLUSIONS: Besides routine treatment, combination of naloxone, heparin and radix salviae miltrorrhizae as early as possible after resuscitation can markedly reduce the degree of hypoxic ischemic brain damage.