新生儿缺氧缺血性脑病急性期钙拮抗剂对血钙影响.doc

新生儿缺氧缺血性脑病急性期钙拮抗剂对血钙影响摘 要 目的：探讨新生儿缺氧缺血性脑病(HIE)急性期钙拮抗剂对血钙的影响。方法：将136例HIE患儿随机分为常规治疗组和尼莫地平治疗组。常规治疗组采用氧疗、脱水、对症、预防感染与营养支持疗法等综合治疗3天；尼膜地平治疗组在常规治疗组基础上加用尼膜地平针静脉给药治疗3日。观察各组在治疗前、治疗12小时、1天、2天和3天时静脉血清总钙水平的变化，并与正常对照组30例比较。结果：HIE常规治疗组和HIE尼莫地平组水平在治疗前显著降低，并持续至治疗的1天以后。至治疗2天时，HIE常规治疗组的血钙浓度仍然处于较低水平，而尼莫地平组却已提前恢复至正常水平。结论：钙拮抗剂对HIE早期治疗，能提前恢复低钙血症作用，血钙的恢复早晚可能是钙拮抗治疗有效的一个判断指标。 关键词 新生儿缺氧缺血性脑病 钙拮抗剂 血清总钙 Abslractl Objective．Study the effect of Ca-antagonist On serum calcium in acut-estage ofhypoxic ischemic encephalopathy(HIE)of newborn.Methods；136 HIE child-patients were randomly divided into conven- tional therapy group andNimodipine-trea- ting group．Patients in conventional therapygroup received treatmentincluding oxygen theiapy，dehydration reatment，symptomatic treatment，infectionprevention and nutritional suppo~for 3 days；patients in Nimodipine-treating groupreceived treatment including above mentioned treating methods and Nimo-dipineinjection for 3 days．Serum total calcium was measured before treatment，12h，1 day 2 days and 3 days after treatment and was compared with that in normal control group(30 normal children)．Results．Serumtotal calcium decreased significantly before treatment in both conventional therapy group and Nimodipine-treating group andlasted to 1 day after treatment．At the 2 day after treatment．serum total calciumreturned to normal in Nimodipine-treating group but was still at 1ow level inconventional therapy group．Conclusion：Serum calcium can return to normal earlierin HIE patients treated with Ca-antagonist and normal serum calcium can be an indexof effective Ca-antagonist treatment． Key Words Hypoxic ischemi(en cephalopathy of newborn；Ca-antagonist：Serumtotal calciums 目前已公认细胞内钙超载对急性缺血性神经元损害起关键作用。因此人们认为阻断或干预钙内流可保护缺血神经元损伤，减轻病情[1]。但目前尚缺乏判断钙拮抗剂对缺血缺氧性脑病(HIE)急性期的干预作用或临床疗效的可靠、敏感指标，故钙拮抗剂对HIE急性期的疗效目前众说纷纭。既然人们已经发现HIE时合并低钙血症，那么，血钙水平的变化能否反映HIE时钙拮抗剂的疗效？笔者将近3年来对此问题的临床研究结果总结分析如下。 资料与方法 病例与分组:2003年5月~2006年12月收住我院新生儿病房的HIE患儿136例，男64例，女72例，全部符合1996杭州会议新生儿缺氧血性脑病的诊断依据与临床分度标