摘要
目的:探讨5例缺氧缺血性脑病新生儿的临床特点、亚低温治疗过程及护理要点。方法:回顾性分析2019年2月至2021年11月北京大学第一医院新生儿重症监护病房（NICU）临床诊断为缺氧缺血性脑病并进行亚低温治疗的新生儿的临床资料，对患儿进行亚低温治疗。结果:共纳入5例患儿。胎龄36+6~40+6周，出生体重2520~4010 g。4例患儿于生后6 h内进行亚低温治疗，1例患儿于生后7 h进行亚低温治疗，5例患儿均采用头部+全身亚低温治疗模式，亚低温治疗持续时间为69.7~72.0 h。亚低温治疗期间给予动态视频脑电图监测（VEEG），1例患儿亚低温治疗期间观察到11次癫痫持续状态，表现为兴奋状态、肌张力增高，脑电图监测到数十次的电发作，1例患儿监测到电发作，均给予镇静药止惊处理。其余3例患儿未监测到临床发作和电发作。4例亚低温治疗后病情稳定，住院11~22 d出院，出院后随访结局良好。结论:亚低温治疗技术是缺氧缺血性脑病新生儿的首选治疗方法。亚低温治疗过程中医护人员需要密切监测患儿的生命体征，进行脑电图监测，识别发作等，加强心动过缓、低血压、低血糖等并发症的观察和护理。
Abstract
Objective:TTo explore the clinical characteristics, hypothermia treatment process, and nursing points of 5 newborns with hypoxic-ischemic encephalopathy.Methods:The clinical data of neonates clinically diagnosed with hypoxic-ischemic encephalopathy at the Neonatal Intensive Care Unit (NICU) of Peking University First Hospital from February 2019 to November 2021 were selected for this retrospective analysis. The newborns were treated with hypothermia.Results:A total of five newborns with hypoxic-ischemic encephalopathy were included. Their gestational age ranged from 36+6 to 40+6 weeks, and their birth weight ranged from 2520 to 4010 g. Four cases were treated with therapeutic hypothermia within 6 hours after birth, and one newborn at 7 hours after birth. All the five children were treated with head+systemic hypothermia, which lasted 69.7 to 72.0 hours. Dynamic video electroencephalographic monitoring (VEEG) was conducted during hypothermia therapy. A total of 11 cases of epileptic state were observed during hypothermia therapy in one newborn, manifesting as excitation state and increased muscle tone and dozens of electrical seizures monitored by VEEG. No clinical seizures or electrical seizures were detected in the remaining three children. Four cases had stable condition after hypothermia treatment and were discharged 11 to 22 days after admission with good follow-up outcomes.Conclusion:Therapeutic hypothermia is a preferred treatment for newborns with oxygen-ischemic encephalopathy. In the process of therapeutic hypothermia, doctors and nurses need to closely monitor the vital signs of the newborns, conduct VEEG monitoring, identify the attacks, and strengthen the observation and care of the complications such as bradycardia, hypotension, and hypoglycemia.
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