Treatment advances in neonatal neuroprotection and neurointensive care.
Treatment advances in neonatal neuroprotection and neurointensive care.
复制标题
新生儿神经保护和神经性护理的治疗进展。
DOI：
10.1016/s1474-4422(11)70016-3
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发表时间：
2011-04
期刊：
影响因子：
48
通讯作者：
Northington, Frances
中科院分区：
文献类型：
--
作者：
Johnston, Michael V.;Fatemi, Ali;Wilson, Mary Ann;Northington, Frances
对新生儿脑部病变的性质、预后以及治疗方法的了解已显著增加。足月儿新生儿缺氧缺血性脑病（HIE）反映了窒息损伤后在大脑中发生的一系列兴奋性氧化事件的级联进展。在实验室中，通过神经保护过程可以阻断这种级联反应以保护脑组织。然而，在三项关于对HIE足月儿进行适度低温治疗的阳性随机对照试验发表之前，缺乏临床效果的证据。这些结果极大地改善了窒息婴儿的治疗前景，并改变了对神经保护理论的理解。研究表明，窒息后6小时内进行适度低温治疗可使无脑瘫或其他残疾的存活率提高约40%，并使死亡或神经残疾率降低近30%。目前正在寻找能够进一步增强低温治疗效果的辅助治疗方法。
Knowledge of the nature, prognosis, and ways to treat brain lesions in neonatal infants has increased remarkably. Neonatal hypoxic-ischaemic encephalopathy (HIE) in term infants, mirrors a progressive cascade of excito-oxidative events that unfold in the brain after an asphyxial insult. In the laboratory, this cascade can be blocked to protect brain tissue through the process of neuroprotection. However, proof of a clinical effect was lacking until the publication of three positive randomised controlled trials of moderate hypothermia for term infants with HIE. These results have greatly improved treatment prospects for babies with asphyxia and altered understanding of the theory of neuroprotection. The studies show that moderate hypothermia within 6 h of asphyxia improves survival without cerebral palsy or other disability by about 40% and reduces death or neurological disability by nearly 30%. The search is on to discover adjuvant treatments that can further enhance the effects of hypothermia.