Гипотермия проводилась следующим образом:
1. Решение охлаждать новорожденного с ГИЭ принимается дежурным врачом.
2. Чтобы быть эффективным, охлаждение должно начаться как можно скорее, то есть, в пределах 6 часов от рождения.
3. Цель состоит в том, чтобы достигнуть заданной температуры в течение 1 часа.
4. Полный период охлаждения и согревания составляет 84 часа, и состоит из 2 фаз:
· Активное охлаждение – в течение 72 часов от начала охлаждения.
новорожденный гипоксический энцефалопатия лечение гипотермия
· Согревание - 12 часов активного постепенного согревания после завершения 72 часов охлаждения.
Результаты исследования
Установлено, что летальность в первой группе составила 1 (20%), во второй группе летальность составила 2 человек (40%).
Длительность судорожного синдрома определялась ретроспективно по записям в врачебных дневниках и в первой группе составила в среднем 2-е суток, тогда как во второй группе судорожный синдром присутствовал в среднем 4 дня.
При оценке длительности нахождения на ИВЛ, выяснилось, что у детей первой группы средняя продолжительность ИВЛ составила 6 дней, тогда как у детей 2 группы эта цифра составила 10 дней. Также определено снижение общего пребывания в ОИТН детей первой группы ( в среднем 10 суток) по сравнению со второй группой (16 суток)
При проведении нейросонографии с доплерографией у детей обеих групп исследовался индекс резистентности в передней мозговой артерии на 3-и сутки жизни.
Ri 1 | Ri 2 | Ri 3 | Ri 4 | Ri 5 | |
1 группа | 0.55 | 0.5 | 0.6 | 0.45 | 0.4 |
2 группа | 0.42 | 0.4 | 0.35 | 0.32 | 0.4 |
Среднее значение Ri в первой группе составило 0,5, а во второй- 0,38 , что свидетельствует о более неблагоприятном прогнозе у детей 2 группы.
Выводы
Выявленные нами различия у детей двух исследуемых групп с гипоксически-ишемической энцефалопатией, позволяют судить о том, что применение тотальной гипотермии у новорожденных с гипоксически-ишемической энцефалопатией:
- Снижает летальность
- Снижает длительность нахождения на ИВЛ
- Снижает длительность пребывания ребёнка в отделении реанимации
- Улучшает гемодинамику в сосудах головного мозга и соответственно увеличивает шанс на благоприятный исход данного заболевания
- Укорачивает длительность судорожного синдрома
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