JAMA:低体温治疗的深度和持续时间对新生儿缺氧缺血性脑病18个月死亡或残疾的影响

2017-07-05 zhangfan MedSci原创

研究表明,足月的中重度缺氧缺血性脑病患儿,超过72小时、低于33.5°C的低体温或两者联合都不能显著降低18个月龄时患儿的死亡或中重度残疾率。研究结果支持目前采用的33.5°C的低体温72小时治疗方案

新生儿缺氧缺血性脑病患儿维持33.5°C的低体温72小时有助于减少死亡与致残率,但风险仍旧较高。近日研究人员考察了120小时的低体温或体温下降至32.0°C 对于缺氧缺血性脑病患儿的效果研究在全美18个尤妮斯甘乃迪施莱佛国立儿童健康与人类发展新生儿研究网络中心开展,时间从2010年10月至2016年月。364名患儿随机分成4组:33.5°C治疗72小时 (n=95),32.0°C 治疗 72 小时(n=90), 33.5°C治疗 120 小时 (n=96)或32.0°C 治疗120 小时 (n=83)。主要终点是18-22个月龄时死亡以及中重度致残。重度致残包括:贝利婴儿认知评分III低于70、大运动功能分类系统(GMFCS)3-5级、失明或听力丧失。中度致残包括认知评分70-84、GMFCS2级、活动性癫痫发作或听力增强。95%的参与者达到主要终点(平均月龄20.7个月,42%为女孩)。低体温72小时以及120小时患儿发生死亡或致残率分别为56例(31.8%)和54例(31.6%) (调整风险 0.92 [95% CI,0.68-1.25]; 调整绝对风险差异,-1.0% [95%

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1663221, encodeId=488d16632215a, content=<a href='/topic/show?id=0b662614513' target=_blank style='color:#2F92EE;'>#低体温#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26145, encryptionId=0b662614513, topicName=低体温)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dcc025584595, createdName=ms920641618706883, createdTime=Sun Oct 08 00:12:00 CST 2017, time=2017-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807053, encodeId=c0d7180e05364, content=<a href='/topic/show?id=245de9378aa' target=_blank style='color:#2F92EE;'>#缺血性脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79378, encryptionId=245de9378aa, topicName=缺血性脑)], attachment=null, authenticateStatus=null, 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style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Mon Mar 19 19:12:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1666399, encodeId=6495166639911, content=<a href='/topic/show?id=55c6849451c' target=_blank style='color:#2F92EE;'>#脑病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84945, encryptionId=55c6849451c, topicName=脑病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=db0126060584, createdName=showtest, createdTime=Tue Dec 12 14:12:00 CST 2017, time=2017-12-12, status=1, ipAttribution=), 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createdName=半夏微凉, createdTime=Wed Jul 05 16:07:15 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218872, encodeId=63df2188e27d, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4Cr8ibeWnmTmmC1lthicNVicicXTX7Mn9OEib5S1eHg4jhM9usWmW2NBVm6NaJurhgeMl3UJ1gujuaQuIX7icVSa8F4JoFPCfib0Prsk/0, createdBy=b5bb2069360, createdName=cherry bomb, createdTime=Wed Jul 05 15:24:12 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218862, encodeId=9a5821886250, content=多在分娩过程中出现, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-12-12 showtest
  6. 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-07 zhwj
  7. 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GetPortalCommentsPageByObjectIdResponse(id=1503633, encodeId=e1b215036331a, content=<a href='/topic/show?id=4f215634296' target=_blank style='color:#2F92EE;'>#持续时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56342, encryptionId=4f215634296, topicName=持续时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13e29684821, createdName=zhwj, createdTime=Fri Jul 07 05:12:00 CST 2017, time=2017-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218883, encodeId=bd49218883f3, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 半夏微凉

    学习了谢谢分享

    0

  8. 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 cherry bomb

    学习了,谢谢分享

    0

  9. 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createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 楠博One

    多在分娩过程中出现

    0

  10. 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createdName=半夏微凉, createdTime=Wed Jul 05 16:07:15 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218872, encodeId=63df2188e27d, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4Cr8ibeWnmTmmC1lthicNVicicXTX7Mn9OEib5S1eHg4jhM9usWmW2NBVm6NaJurhgeMl3UJ1gujuaQuIX7icVSa8F4JoFPCfib0Prsk/0, createdBy=b5bb2069360, createdName=cherry bomb, createdTime=Wed Jul 05 15:24:12 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218862, encodeId=9a5821886250, content=多在分娩过程中出现, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/05/25/aee510ed68ce4736e9fe4ec7d03c01b1.jpg, createdBy=ce892064652, createdName=楠博One, createdTime=Wed Jul 05 15:02:50 CST 2017, time=2017-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=218856, encodeId=523b218856fd, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Wed Jul 05 14:51:32 CST 2017, time=2017-07-05, status=1, ipAttribution=)]
    2017-07-05 Y—xianghai

    学习了新知识

    0