楊順發趙玉華YANG, SHUN-FACHAO, YU-HUA彭瀠萱PENG, YINH HSUANYINH HSUANPENG醫學研究所碩士班2026-10-292025-06-2320252025-06-06https://handle.ncl.edu.tw/11296/g2yqndhttps://scholars.csmu.edu.tw/handle/123456789/36730研究背景與目的:缺氧缺血性腦病變是造成新生兒腦部損傷的主要原因之一， 亦是後續導致嚴重併發症或死亡的重要因素。在黃金時間內，早期診斷缺氧缺 血性腦病變與儘快開始進行低溫治療對長期預後至關重要。本研究旨在探討中 度至重度缺氧缺血性腦病變之新生兒接受低溫治療後的死亡率，並分析影響缺氧缺血性腦病變嚴重度和死亡率的相關因素。研究方法:本研究為單一醫學中心之回溯性病例資料研究，收集了 2019 年 1 月 1 日至 2024 年 12 月 31 日間，入住台灣中部某一醫學中心新生兒加護病房之缺 氧缺血性腦病變新生兒，總共有 128 位，依據 Sarnat 分期分為三組，Sarnat 第 一期的有 46 位、Sarnat 第二期的有 57 位、Sarnat 第三期的有 25 位，所有 Sarnat 第二期與第三期之新生兒皆於出生後 6 小時內，接受為期 72 小時的低溫 治療。分析多項可能與缺氧缺血性腦病變嚴重度和死亡率相關的因子，包括出 生週數、出生體重、分娩方式、Apgar 評分，以及出生後送達醫院時的初始抽 血檢查，包括乳酸、乳酸去氫酶、肌酸激酶、心肌旋轉蛋白、丙胺酸轉胺酶、 肌酸、白蛋白、血糖、鈉離子、鉀離子、C 反應蛋白、白血球計數、血色素、 血小板計數、凝血酶原時間、部分凝血活酶時間等。研究結果:接受低溫治療的 82 位 Sarnat 第二期與 Sarnat 第三期之缺氧缺血性 腦病變新生兒中有 12 位死亡，死亡率為 14.6%;其中 Sarnat 第二期 57 人中有 1 人死亡，死亡率為 1.8%，Sarnat 第三期 25 人中有 11 人死亡，死亡率為 44%。缺氧缺血性腦病變的嚴重度與多項因素有顯著相關，包括第一分鐘的 Apgar 評分、第五分鐘的 Apgar 評分、血中乳酸與肌酸激酶濃度、血糖;進一 步多變項邏輯迴歸分析發現，血中乳酸濃度(P=0.002，勝算比:1.023)與血糖 (P=0.009，勝算比:1.014)可為缺氧缺血性腦病變嚴重度的獨立預測因子。此 外，死亡率亦與多項因素顯著相關，包括第一分鐘的 Apgar 評分、第五分鐘的Apgar 評分、分娩方式、血中乳酸與肌酸激酶濃度、血糖和血小板計數;多變 項邏輯迴歸分析可發現，血糖(P=0.005，勝算比:1.025)與血小板計數 (P=0.040，勝算比:0.979)為缺氧缺血性腦病變死亡率的獨立預測因子。結論:本研究結果顯示，中度至重度缺氧缺血性腦病變之新生兒接受低溫療法 後的死亡率為 14.6%;其中重度 Sarnat 第三期之死亡率更高達 44%。血中乳酸 濃度高與缺氧缺血性腦病變的嚴重度相關，剖腹產和血小板計數低與缺氧缺血 性腦病變的死亡率相關，而 Apgar 評分低和血糖濃度高則與缺氧缺血性腦病變的嚴重度和死亡率皆有關聯。Objective: Hypoxic-ischemic encephalopathy (HIE) is the leading cause of neonatal brain injury and is a significant contributing factor of morbidities and mortality in neonates. This study aimed to investigate the mortality rate in neonates with HIE receiving hypothermia therapy and to analyze factors associated with HIE severity and mortality.Methods: We conducted a retrospective study at a single medical center. From January 1, 2019 to December 31, 2024, a total of 128 neonates with HIE admitted in the neonatal intensive care unit were included for analysis. They were classified into three groups based on the Sarnat staging system: 46 were classified as stage 1, 57 as stage 2, and 25 as stage 3. All neonates with stages 2 and 3 HIE received hypothermia therapy within 6 hours after birth, and the therapy lasted for 72 hours. Factors potentially associated with mortality were analyzed, including gestational age, birth body weight, mode of delivery, Apgar score, and laboratory tests immediately after birth. Laboratory tests included lactate, lactate dehydrogenase, creatine phosphokinase, troponin-T, alanine transaminase, creatinine, albumin, glucose, sodium, potassium, C-reactive protein, white blood cell count, hemoglobin, platelet count, prothrombin time, and activated partial thromboplastin time.Results: Twelve of the 82 neonates with stage 2 and stage 3 HIE receiving hypothermia therapy died, and the mortality rate was 14.6%. The mortality rates were 1.8% (1 of 57) in stage 2 HIE and 44% (11 of 25) in stage 3 HIE, respectively. Several factors were significantly associated with HIE severity, including Apgar score at the first minute, Apgar score at the fifth minute, lactate levels, creatine phosphokinase levels, and glucose levels. Further multiple regression analysis revealed that serum lactate levels (P=0.002, OR: 1.023) and glucose levels (P=0.009, OR: 1.014) were independent predictors of HIE severity. On the other hand, factors significantly associated with mortality were Apgar score at the first minute, Apgar score at the fifth minute, mode of delivery, lactate levels, creatine phosphokinase levels, glucose levels, and platelet counts. Serum glucose levels (P=0.005, OR: 1.025) and platelet counts (P=0.040, OR: 0.979) were independent predictors of mortality in these neonates.Conclusions: In our study, the mortality rate in neonates with stage 2 and stage 3 HIE receiving hypothermia was 14.6%. A significantly higher mortality rate of 44% was noted in stage 3 HIE. There were significant correlations between elevated lactate levels and HIE severity and between caesarean section, decreased platelet counts and mortality. Meanwhile, low Apgar score and elevated glucose levels were associated with both HIE severity and mortality.嚴重度低溫治療缺氧缺血性腦病變死亡率severityhypothermia therapyhypoxic-ischemic encephalopathymortalitythesis