Clinical study of mild hypothermia combined with cerebroprotein hydrolysate in the treatment of neonatal asphyxia brain injury and its influence on blood GFAP
MU Yanshun LIU Weijuan GAO Jialing LIU Hongwei FAN Qingman
Department of Pediatrics, Huabei Petroleum Administration Bureau General Hospital, Hebei Province, Renqiu 062552, China
Abstract:Objective To observe the effect of mild hypothermia combined with cerebroprotein hydrolysate in the treatment of neonatal asphyxia brain injury and its influence on blood glial fibrillary acidic protein (GFAP). Methods Retrospective analysis was performed on 81 cases of neonatal asphyxia with moderate and severe brain injury admitted to Department of Neonatology, Huabei Petroleum Administration Bureau General Hospital from May 2018 to May 2020. According to the drug use, they were divided into cerebroprotein hydrolysate group (40 cases) and mild hypothermia combined with cerebroprotein hydrolysate group (41 cases). Two groups were given symptomatic support treatment, such as maintaining electrolyte balance, reducing intracranial pressure, anti infection, intravenous nutrition support, etc. Cerebroprotein hydrolysate group was treated with Trixerutin Brain Protein Hydrolysate Injection and mild hypothermia combined with cerebroprotein hydrolysate group was combined with head mild hypothermia treatment on the basis of cerebroprotein hydrolysate group. The consciousness recovery time, muscle tension recovery time, primary reflex recovery time and blood GFAP level were compared between two groups. Results The consciousness recovery time, muscle tension recovery time, primary reflex recovery time in mild hypothermia combined with cerebroprotein hydrolysate group were shorter than those in cerebroprotein hydrolysate group (all P < 0.05). Before treatment, there was no significant difference in blood GFAP level between the two groups (P > 0.05). After seven days of treatment, the blood GFAP level in both groups were higher than those before treatment and after three days of treatment. After three days of treatment, the blood GFAP level in both groups were higher than those before treatment (all P < 0.05). After three, seven days of treatment, the blood GFAP level of the mild hypothermia combined with cerebroprotein hydrolysate group were lower than those of cerebroprotein hydrolysate group (all P < 0.05). Conclusion Mild hypothermia combined with cerebroprotein hydrolysate can significantly improve the clinical manifestations of neonatal asphyxia brain injury and the detection of blood GFAP is helpful for the prognosis of neonatal asphyxia brain injury.
穆艳顺 刘伟娟 高嘉陵 刘红伟 樊青曼. 亚低温联合脑蛋白水解物治疗新生儿窒息脑损伤的临床研究及对血GFAP的影响[J]. 中国医药导报, 2021, 18(6): 119-122.
MU Yanshun LIU Weijuan GAO Jialing LIU Hongwei FAN Qingman. Clinical study of mild hypothermia combined with cerebroprotein hydrolysate in the treatment of neonatal asphyxia brain injury and its influence on blood GFAP. 中国医药导报, 2021, 18(6): 119-122.
[1] Dilenge ME,Majnemer A,Shevell MI,et al. Long-term developmental outcome of asphyxiated term neonates [J]. J Child Neurol,2001,16(11):781-792.
[2] Spitzmiller RE,Phillips T,Meinzen-Derr J,et al. Amplitude-integrated EEG is useful in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischemic encephalopathy:a meta-analysis [J]. J Child Neurol,2007,22(9):1069-1078.
[3] Hayes BC,Doherty E,Grehan A,et al. Neurodevelopmental outcome in survivors of hypoxic ischemic encephalopathy without cerebral palsy [J]. Eur J Pediatr,2018,177(1):19-32.
[4] 李芳,刘华,肖东杰,等.新生儿缺氧缺血性脑病神经保护研究现状[J].中国实用儿科杂志,2017,32(8):631-635.
[5] 刘鹏,何珊,左泽兰,等.亚低温治疗新生儿缺血缺氧脑病疗效及远期预后的Meta分析[J].重庆医学,2020,49(5):796-801.
[6] 王彤,王丽娟,付洪涛,等.局部及全身亚低温疗法针对早产儿窒息治疗效果的对比分析[J].广西医科大学学报,2020,37(4):727-731.
[7] 韩笑艳,申灿学.选择性头部亚低温联合脑蛋白水解物注射液对新生儿缺血缺氧性脑病血清Caspase-3、ICAM-1水平的影响[J].首都食品与医药,2020,27(18):84-85.
[8] 万静,游勇,陈晓燕,等.3种中枢神经营养药物治疗新生儿缺氧缺血性脑病临床疗效的对比研究及卫生经济学评价[J].实用心脑肺血管病杂志,2019,27(7):79-82.
[9] 穆艳顺,刘伟娟,高嘉陵,等.亚低温联合脑苷肌肽治疗新生儿窒息脑损伤的临床效果及对血NO的影响[J].中国医药导报,2020,17(9):99-102.
[10] 江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2015:468-471.
[11] Wen HZ,Guo QC,Xiao MS,et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy:a multicenter randomized controlled trial in China [J]. J Pediatr,2010,157:367-372.
[12] Cai Q,Xue XD,Fu JH,et al. Research status and progress of neonatal hypoxic ischemic encephalopathy[J]. Chin J Pract Pediatr,2009,24:968-971.
[13] Hong YL,Qiu LW,Su JW,et al. Neonatal hypoxic ischemic encephalopathy-related biomarkers in serum and cerebrospinal fluid [J]. Clin Chim Acta,2015,450:282-297.
[14] Kurinczuk JJ,White KM,Badawi N,et al. Epidemiology ofneonatal encephalopathy and hypoxic-ischaemic encephalopathy [J]. Early Hum Dev,2010,86(6):329-338.
[15] Caroline EA,Geraldine BB,Deirdre MM,et al. Short and long term prognosis in perinatal asphyxia:An update[J]. World J Clin Pediatr,2016,5(1):67-74.
[16] Wen J,Xiao PL,Wen BD,et al. Benefits of starting hypothermia treatment within 6 h vs. 6-12 h in newborns with moderate neonatal hypoxic-ischemic encephalopathy [J]. BMC Pediatrics,2018,18:50-58.
[17] Northington FJ,Chavez VR,Martin LJ,et al. Neuronal cell death in neonatal hypoxia-ischemia [J]. Ann Neurol,2011,69(5):743-758.
[18] Michael VJ,Ali F,Mary AW,et al. Treatment advances in neonatal neuroprotection and neurointensive care[J]. Lancet Neurol,2011,10(4):372-382.
[19] 刘翼昌,曾宪靖,刘秋英,等.不同起始浓度氧复苏方案抢救足月新生儿窒息的效果比较[J].中国当代医药,2020, 27(27):96-98.
[20] Guido W,Eleanor RG,Paul PD,et al. The mechanisms and treatment of asphyxial encephalopathy [J]. Front Neurosci,2014,8:40.
[21] Alistair JG,Abbot RL,Nicola JR,et al. Therapeutic hypothermia translates from ancient history in to practice [J]. Pediatr Res,2017,81(1):202-209.
[22] Martha DE,Michael DW. Hypoxic ischemic encephalopathy:a review for the clinician[J]. JAMA Pediatr,2015, 169(4):397-403.
[23] Konstantinou EA,Venetsanou K,Mitsos AP,et al. Neuron specific enolase NSE:a valuable prognostic factor of central nervous system dysfunction following cardiac surgery [J]. Brit J Anaesthet Rec Nur,2008,19:22-28.
[24] Yal?觭?覦n ?覶,Aytug A,Selvi G,et al. The effects of selective head cooling versus whole-body cooling on some neural and inflammatory biomarkers:a randomized controlled pilot study [J]. Ital J Pediatr,2015,41:79.
[25] Jin QS,Jin L,Guo QC,et al. Effects of hypothermia on NSE and S-100 protein levels in CSF in neonates following hypoxic/ischaemic brain damage [J]. Acta Paediatr,2012,101(8):e316-e320.
[26] Stephanie LM,Fahad FM,Allen DE,et al. Glial fibrillary acidic protein as a biomarker for brain injury in neonatal CHD [J]. Cardiol Young,2016,26(7):1282-1289.
[27] 凌寅杰,朱焰,施明杰,等.GFAP联合cfDNA测定在复杂性热性惊厥脑损伤中的临床研究[J].中国现代医生,2020,58(17):29-32.
[28] 刘春丽,梅花,张亚昱,等.血清GFAP结合颅脑MRI检查在新生儿缺氧缺血性脑病中的临床价值[J].中国医师杂志,2019,21(11):1621-1625.
[29] 张方.曲克芦丁脑蛋白水解物治疗缺血性脑卒中的应用概况[J].中国社区医师,2020,36(1):7-9.
[30] 曾卓琴.曲克芦丁脑蛋白水解物应用患者不良反应发生情况研究分析[J].中国医药科学,2020,10(9):48-50.