| Background：With the popularizing of resuscitation technique onneonatal asphyxia, the occuring rate of asphyxia of newborn isdecreased, and with the developing of the neonatal intensive careunit,intensive care technique as well, the survival rate of the criticalneonates is obviously increased. For all this, neonatal asphyxia andhypoxic ischemic encephalopathy are still the main reason for perinatalmortality,brain paralysis and dysgnosis.The mechanism of hypoxicischemic encephalopathy has not yet been fully elucidated, and it ismulti-factors that attributed to HIE. Former research focus mainly on theprimary energy failure, secondary energy failure, excitability amino acidtoxic effects,calcium influx and so on. New progress in the researchincludes reperfusion, oxidative stress, inflammatory damage, nerve cellapotosis.The current research about hypoxic ischemic encephalopathy hasnot yet been a breakthrough,still stressed the first three days ofsymptomatic support treatment,namely three support symptomatictreatment, but these conventional treatment methods are not sure canchange the prognosis of HIE.Neuroprotective drugs research includeneurovascular improve drug, MK801,IGF21,EPO,these drugs or becausethe sample size is small, such as clinical efficacy remains to be proved,or because of adverse reactions, in neonatal clinical use hard, or iscurrently in animal experiment stage, therefore, neural protection ofdrug treatment is still no breakthrough. The domestic studies ofhyperbaric oxygen HIE hyperbaric oxygen treatment in the near future curative effect is distinct, but are small sample centers reported that bothat home and abroad are lack of large sample multicenter study Aboutpressure low temperature treatment, since2005,many developedcountries such as the United States is the systemic pressure lowtemperature treatment and selectivity of neonatal encephalopathy headlow temperature treatment international multi-center RCTs proved thatthe pressure of the cryogenic treatment effectiveness and safety ofneonatal HIE but pressure can reduce the morality of HIE in lowtemperature and the incidence of nerve dysfunction, can improve thelong-term prognosis of HIE,pressure low temperature regional cerebralblood flow, children with HIE how changes in the local cerebralmetabolic pathological physiology, still need to be further in-depth study.PET/CT is currently the most advanced medical equipment, molecularimaging can provide PET images and CT images at the same time,realize the complementary functional and anatomical images and fusion isthe latest PET/CT represents the highest level of the development ofinternational medical imaging today PET/CT in the central nervoussystem diseases can provide many have diagnostic value of data, such aslocal blood flow measurement, regional cerebral oxygen metabolism rateof regional cerebral oxygen intake fraction of regional cerebral bloodflow volume, etc. Can also use18F-FDG PET directly according to theclinical use of the local energy metabolism of brain tissue status PET/CTmainly in adults in neonatal diseases using the current lack of relatedresearch but theoretically in the diagnostic efficacy of neonatal HIEprognosis monitoring PET/CT has widely application value, worthy offurther research.objective: To diccuss the comparisons, divide neonates owedthirty-six’s pregnance into two groups.Conventional treatment groupuses convential symptomatic treatment, the group in mild hypothermia therapy is on the basis of convential treatment addicted by hypothermiatreatment. The first comparison is the changes of glucosemetabolism before treatment and after treatment, as well as theamplitude-integrated electroencephalogram in the baby’s first day andseven’s day. The conclusion is provided to proving the validation ofhypothermia therapy in neonatal HIE.Methods:63newborns with Severe HIE(all of them werehospitalized in NICU of the Affiliated Hospital of Luzhou MedicalCollege from May.2012to Sep.2013) are divided into two groups.Conventional treatment group26cases using conventional symptomatictreatment. The group of37cases in mild hypothermia therapy, on thebasis of conventional treatment combined with mild hypothermiatreatment. Observe two groups the changes in glucose metabolism rate on18F-FDG PET/CT before treatment and after treatment., respectively thethalamus, basal ganglia, frontal, parietal and occipital glucose metabolicrate (SUV) value of the average standard of perturbation，as well as theamplitude-integrated electroencephalogram in the baby’s first day andseven’s day. The conclusion is provided to proving the validation ofhypothermia therapy in neonatal HIE.Results:1Mild hypothermia therapy group and conventional treatment grouphad no obvious difference in gestational age, birth weight, admissionage,gender difference（P>0.05）.2Various brain regions after treatment compared with beforetreatment, mild hypothermia therapy group and conventional treatmentgroup after treatment,the brain tissue energy metabolism were improved(P<0.001). Various brain regions compared between the two groupsbefore treatment had no obvious difference（P﹥0.05）. Hypothermia treatment group proportion of energy metabolism return to normal aftertreatment was obviously higher than that of conventional treatment group(P<0.001).3Hypothermia treatment group proportion of energy metabolismreturn to normal after treatment was obviously higher than that ofconventional treatment group (P<0.001). Conventional treatment groupand hypothermia treatment group had no obvious difference in theamplitude-integrated electroencephalogram on the first day(P>0.05),however, hypothermia treatment group was obviously higher thanconventional treatment group on the seven day(P<0.05).4In the hypothermia treatment group,one case was trouble withthrombocytonia, none of the neonates in experiment had side effectcaused by18F-FDG PET/CT.Conclusions：Hypothermia treatment can better promote neonatalhypoxic ischemic encephalopathy cells energy metabolism return tonormal.18F-FDG PET/CT can better evaluate the status of the neonatalbrain energy metabolism. hypothermia treatment and18F-FDG PET/CTare safe in clinical areas. |
PDF Full Text Request