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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
李建波, 吴文燊, 杜邦, 徐凤丹, 李宁, 列锦艮, 何晓光
中国当代儿科杂志 ›› 2021, Vol. 23 ›› Issue (2) : 133-137.
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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
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。
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 (3 439±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.
Hypoxic-ischemic encephalopathy / Mild hypothermia / Hemodynamics / Neonate
[1] Chiang MC, Jong YJ, Lin CH. Therapeutic hypothermia for neonates with hypoxic ischemic encephalopathy[J]. Pediatr Neonatol, 2017, 58(6):475-483.
[2] Catherine RC, Ballambattu VB, Adhisivam B, et al. Effect of therapeutic hypothermia on the outcome in term neonates with hypoxic ischemic encephalopathy-a randomized controlled trial[J]. J Trop Pediatr, 2020. DOI:10.1093/tropej/fmaa073. Epub ahead of print.
[3] Carreras N, Alsina M, Alarcon A, et al. Efficacy of passive hypothermia and adverse events during transport of asphyxiated newborns according to the severity of hypoxic-ischemic encephalopathy[J]. J Pediatr (Rio J), 2018, 94(3):251-257.
[4] Natarajan G, Laptook A, Shankaran S. Therapeutic hypothermia:how can we optimize this therapy to further improve outcomes?[J]. Clin Perinatol, 2018, 45(2):241-255.
[5] Wood T, Thoresen M. Physiological responses to hypothermia[J]. Semin Fetal Neonatal Med, 2015, 20(2):87-96.
[6] Popescu MR, Panaitescu AM, Pavel B, et al. Getting an early start in understanding perinatal asphyxia impact on the cardiovascular system[J]. Front Pediatr, 2020, 8:68.
[7] Chen K, Schenone AL, Gheyath B, et al. Impact of hypothermia on cardiac performance during targeted temperature management after cardiac arrest[J]. Resuscitation, 2019, 142:1-7.
[8] Ameloot K, Meex I, Genbrugge C, et al. Hemodynamic targets during therapeutic hypothermia after cardiac arrest:a prospective observational study[J]. Resuscitation, 2015, 91:56-62.
[9] Inoue A, Hifumi T, Yonemoto N, et al. The impact of heart rate response during 48-hour rewarming phase of therapeutic hypothermia on neurologic outcomes in out-of-hospital cardiac arrest patients[J]. Crit Care Med, 2018, 46(9):e881-e888.
[10] Wu TW, Tamrazi B, Soleymani S, et al. Hemodynamic changes during rewarming phase of whole-body hypothermia therapy in neonates with hypoxic-ischemic encephalopathy[J]. J Pediatr, 2018, 197:68-74.e2.
[11] Yoon JH, Lee EJ, Yum SK, et al. Impacts of therapeutic hypothermia on cardiovascular hemodynamics in newborns with hypoxic-ischemic encephalopathy:a case control study using echocardiography[J]. J Matern Fetal Neonatal Med, 2018, 31(16):2175-2182.
[12] 吴文燊, 何晓光, 林淑莲, 等. 阻抗法与多普勒超声心动图法测量新生儿心输出量一致性研究[J]. 实用休克杂志(中英文), 2018, 2(3):166-168.
[13] 中华医学会儿科学分会新生儿学组. 新生儿缺氧缺血性脑病诊断标准[J]. 中国当代儿科杂志, 2005, 7(2):97-98.
[14] 卫生部新生儿疾病重点实验室, 复旦大学附属儿科医院. 亚低温治疗新生儿缺氧缺血性脑病方案(2011)[J]. 中国循证儿科杂志, 2011, 6(5):337-339.
[15] Alogna A, Manninger M, Schwarzl M, et al. Inotropic effects of experimental hyperthermia and hypothermia on left ventricular function in pigs-comparison with dobutamine[J]. Crit Care Med, 2016, 44(3):e158-e167.
[16] Marks K, Shany E, Shelef I, et al. Hypothermia:a neuroprotective therapy for neonatal hypoxic ischemic encephalopathy[J]. Isr Med Assoc J, 2010, 12(8):494-500.
[17] Giesinger RE, Bailey LJ, Deshpande P, et al. Hypoxic-ischemic encephalopathy and therapeutic hypothermia:the hemodynamic perspective[J]. J Pediatr, 2017, 180:22-30.e2.
[18] Silveira RC, Procianoy RS. Hypothermia therapy for newborns with hypoxic ischemic encephalopathy[J]. J Pediatr (Rio J), 2015, 91(6 Suppl 1):S78-S83.
[19] Liu G, Li ZG, Gao JS. Hypothermia in neonatal hypoxic-ischemic encephalopathy (HIE)[J]. Eur Rev Med Pharmacol Sci, 2017, 21(4 Suppl):50-53.
[20] Wassink G, Davidson JO, Dhillon SK, et al. Therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy[J]. Curr Neurol Neurosci Rep, 2019, 19(2):2.
[21] Castellani JW, Young AJ. Human physiological responses to cold exposure:acute responses and acclimatization to prolonged exposure[J]. Auton Neurosci, 2016, 196:63-74.
[22] 李爱丽. 新生儿缺氧缺血性脑病脑动脉血流动力学变化及对预后的影响[J]. 中国实用神经疾病杂志, 2018, 21(10):1088-1092.
[23] Yoon JH, Lee EJ, Yum SK, et al. Impacts of therapeutic hypothermia on cardiovascular hemodynamics in newborns with hypoxic-ischemic encephalopathy:a case control study using echocardiography[J]. J Matern Fetal Neonatal Med, 2018, 31(16):2175-2182.
[24] Azzopardi D. Clinical management of the baby with hypoxic ischaemic encephalopathy[J]. Early Hum Dev, 2010, 86(6):345-350.
[25] Rhee CJ, da Costa CS, Austin T, et al. Neonatal cerebrovascular autoregulation[J]. Pediatr Res, 2018, 84(5):602-610.
东莞市科技计划一般项目（202050715028809）。
