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醫(yī)學(xué)論文范文:硫酸鎂聯(lián)合多巴胺治療新生兒缺氧缺血性腦病的臨床研究
【摘要】 目的 探討硫酸鎂聯(lián)合多巴胺對新生兒缺氧缺血性腦病(HIE)的腦保護(hù)作用。方法 將60例患兒隨機(jī)分為硫酸鎂聯(lián)合多巴胺組(D)、單用硫酸鎂組(L)、生理鹽水組(C)三組，同時設(shè)立正常對照組(N)，分別測定各組入院時及入院后48 h、72 h 和7天各時間點(diǎn)血清S100β蛋白、肌酸激酶腦型同工酶(CK-BB)，并于治療期間監(jiān)測患兒呼吸、心率和血壓的變化。結(jié)果 D組和L組患兒入院后48 h、72 h與7天時血S100β蛋白、CK-BB濃度增加明顯小于C組(P<0.01，P<0.05)，D組患兒呼吸抑制、心率和血壓變化的發(fā)生率明顯低于L組。結(jié)論 硫酸鎂聯(lián)合多巴胺對HIE患兒有腦保護(hù)作用，同時減少了單用硫酸鎂的不良反應(yīng)。
【關(guān)鍵詞】 硫酸鎂;多巴胺;新生兒缺氧缺血性腦病
Effects of magnesium sulfate combined with dopamine on hypoxic-ischemicencephalopathy in neonatesYANG Lijuan, YANG Xiaochun, YUAN Yufang(The Affiliated Huai′an First Hospital of Nanjing Medical University, Huai′an, Jiangsu 223300, China)Abstract： Objective To investigate the protective effect of magnesium sulfate combined with dopamine on the brain of neonates with hypoxic-ischemic encephalopathy (HIE). Methods 60 neonates with HIE were randomly divided into magnesium sulfate with dopamine group (D), magnesium sulfate alone group (L) and normal saline group (C) to contrast with the normal control group (N). Serum levels of creatine phosphokinase isoenzyme BB (CK-BB) and S-100β protein were observed in the 4 groups at different time points (admission and 48 h, 72 h and 7 days of hospitalization). The variations in respiration rate, heart rate and blood pressure were monitored during the treatment.Results Compared with group N, the increase in serum levels of CK-BB and S100β protein in groups D and L was evidently smaller than that in group C (P<0.01, P<0.05), and group D had a lower incidence of respiratory depression, variations in heart rate and blood pressure than group L. Conclusion Magnesium sulfate combined with dopamine significantly protects neonates with HIE from brain insult, without the adverse reactions caused by the administration of magnesium sulfate alone.
Key words：magnesium sulfate; dopamine; hypoxic-ischemic encephalopathy
新生兒缺氧缺血性腦病(hypoxic-ischemic encephalopathy，HIE)是導(dǎo)致新生兒早期死亡和影響遠(yuǎn)期神經(jīng)預(yù)后的重要疾病，發(fā)病機(jī)制十分復(fù)雜，臨床治療也頗多爭議，尤其遠(yuǎn)期神經(jīng)系統(tǒng)預(yù)后一直是困擾臨床的棘手問題。盡管有關(guān)HIE防治的研究頗多，但目前仍未取得明顯突破。最近我們用神經(jīng)保護(hù)藥硫酸鎂聯(lián)合中小劑量的多巴胺治療HIE取得較好的臨床效果,報告如下醫(yī)學(xué) 全在.線提供m.zxtf.net.cn。
1 資料和方法
1.1 一般資料 我科新生兒監(jiān)護(hù)病房(NICU)2006年9月—2008年12月收治的臨床分度為中、重度的HIE[1]患兒60例，排除藥物等因素引起新生兒抑制或心、肺、腦等先天畸形而致神經(jīng)系統(tǒng)異常者;均為足月兒，胎齡 37～42周,出生體重 2.5～4.0 kg，均系生后 6 h內(nèi)轉(zhuǎn)入NICU。
