Treatment methods for hypoxic-ischemic encephalopathy

The treatment of hypoxic-ischemic encephalopathy should focus on prevention, especially if the fetus is in distress in the womb. Pregnant women should pay attention to timely oxygen supply. After birth, infants should be allowed to lie flat, with less disturbance and keep breathing smooth.

1. Oxygen supply: Choose various oxygen supply methods according to the patient's condition, keep blood oxygen PaO2 above 6.6-5.9.31 kPa (50-70 mmHg), and PaCO2 below 5.32 kPa (40 mmHg), but be sure to prevent PaCO2 from being too low to avoid reduced cerebral blood flow.

2. Maintain normal blood pressure and avoid excessive fluctuations in blood pressure to maintain stable cerebral blood perfusion. When blood pressure is low, dopamine (continuous intravenous drip of 3 to 10 μg/kg/min) and dobutamine (continuous intravenous drip of 3 to 10 μg/kg/min) can be used, and blood pressure can be monitored.

3. Correct metabolic disorders. Mild acidosis and respiratory acidosis can be corrected after improving ventilation. Sodium bicarbonate is only used in moderate to severe metabolic acidosis. The dosage should not be too large to maintain blood pH at 7.3-7.4. In case of hypotension, intravenous drip of 10% glucose was used, with the first dose being 2 ml/kg and the subsequent doses being 5 ml/kg?h, to maintain blood sugar at 2.80-5.04 mmol/L (50-90 ml/dl). Since endorphins increase after asphyxia, some people have tried using naloxone (naloxone) intravenous drip 5-10μg/kg?h, up to a total amount of 0.1mg/kg?d, to antagonize endorphins.

4. To control convulsions, a loading dose of 15-20 mg/kg of phenobarbital can be used by intravenous drip, and a maintenance dose of 3-5 mg/kg/d can be used after 12 hours.

5. Control cerebral edema and limit fluid intake to 60-80 ml/kg/d. Mannitol can be used as a dehydrating agent, 0.5-0.75/kg each time, once every 4-6 hours, but the dehydrating agent should not be overdosed. Although dehydrating agents can reduce cerebral edema, they cannot reduce brain damage.