足月小于胎龄儿危险因素及振幅整合脑电图对其监测意义的研究

发布时间：2018-03-03 06:05

  本文选题：足月小于胎龄儿　切入点：宫内发育迟缓　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的宫内发育迟缓对足月新生儿脑功能成熟度的影响;探讨不同出生体重对足月小于胎龄儿脑成熟度的影响。方法将纳入研究的足月小于胎龄儿按体重百分位数分3组,即体重小于第3百分位数组、体重介于第3百分位数和第5百分位数组、体重大于第5百分位数组,分别定义为组1、组2、组3,同期选取足月适于胎龄儿做对照,即适于胎龄儿组,定义为组4,每组各35例。所有新生儿均在家属知情同意下于出生后72小时内进行a EEG的监测,每次至少监测2小时,同时记录患儿住院期间的一般情况。对所有患儿的a EEG监测结果,采用脑功能监测评分系统对连续性、睡眠周期、下边界及宽度分别进行评分,并计算总评分,比较各组新生儿脑功能发育情况。结果1.10 min Apgar评分、出生胎龄、体重比较足月小于胎龄儿组(组1、组2、组3)与适于胎龄儿组(组4)10 min Apgar评分、出生胎龄比较无统计学意义(P0.05)。足月小于胎龄儿组出生体重为(2215±273g),适于胎龄儿组出生体重为(2853±291g),差异具有统计学意义(P0.01)。各组间出生体重比较均有统计学意义(P0.05)。2.足月小于胎龄儿母亲产科情况小于胎龄儿母亲妊娠期高血压疾病、多胎妊娠、流产史、胎盘脐带异常的发生率高于适于胎龄儿,差异有统计学意义(P0.05)。足月小于胎龄儿母亲与适于胎龄儿母亲在胆汁淤积症、吸烟方面的比较没有差异(P0.05)。3.住院期间一般情况足月小于胎龄儿与适于胎龄儿在恢复至出生体重时长、体重最大下降百分比的比较无统计学意义(P0.05)。足月小于胎龄儿口饲时间、肠外营养时间均长于适于胎龄儿,差异有统计学意义(P0.05)。足月小于胎龄儿中出现喂养不耐受、感染、红细胞增多症的比例高于适于胎龄儿,差异有统计学意义(P0.05)。4.各组脑功能监测结果组1 aEEG表现为连续性差图形、未见明显睡眠周期、波谱带宽度宽;组2a EEG新生儿表现为连续性稍差图形、可见睡眠周期、波谱带宽度稍宽;组3 a EEG表现为连续性渐好图形、易辨认睡眠周期、波谱带宽度窄;组4 a EEG表现为连续性图形、成熟的睡眠周期、波谱带宽度窄。组1、组2、组3、组4在连续性评分、睡眠周期评分、下边界评分、宽度评分、总评分方面比较,差异均有统计学意义(P0.001)。组1新生儿连续性评分、睡眠周期评分、下边界评分、宽度评分、总评分明显低于组2、组3和组4,且差异有统计学意义(P0.05)。组2新生儿连续性评分、睡眠周期评分、下边界评分、宽度评分、总评分明显低于组3和组4,且差异有统计学意义(P0.05)。组3新生儿连续性评分、睡眠周期评分、下边界评分、宽度评分、总评分明显低于组4,且差异有统计学意义(P0.05)。结论1.母亲妊娠期高血压疾病、多胎妊娠、流产史、胎盘脐带异常是足月小于胎龄儿发生的危险因素。2.足月小于胎龄儿住院期间口饲时间、肠外营养时间时长较长,且更容易出现喂养不耐受、感染、红细胞增多症等并发症。3.足月小于胎龄儿脑成熟度落后于适于胎龄儿,而且脑成熟度与出生体重百分位数具有相关性,即足月小于胎龄儿出生体重百分位数越小,脑功能越不成熟。4.a EEG监测能够评估足月小于胎龄儿脑成熟度,具有良好的临床价值。
[Abstract]:The purpose of intrauterine growth retardation effects on brain function of newborn maturity; to investigate the effects of different birth weight of normal gestational age of brain maturation. Methods included in the study of the normal gestational age by weight percentile were divided into 3 groups, namely the weight less than the third percentile array, weighing between third percentile and the fifth percentile array, weight is greater than the fifth percentile array are respectively defined as group 1, group 2, group 3, selected full-term AGA group as control group, which is appropriate for gestational age, defined as group 4, 35 cases in each group. All the infants were monitored in families under informed consent in 72 hours after birth of a EEG, at least 2 hours monitoring, and record the general condition during hospitalization. All the children were a EEG monitoring results, using brain function monitoring scoring system for continuity, sleep cycle, the lower boundary and width respectively were scored, and Calculate the total score, compared the development of neonatal brain function. Results 1.10 min Apgar score, gestational age, body weight compared with full-term gestational age group (group 1, group 2, group 3) and appropriate for gestational age group (Group 4) 10 min Apgar score, gestational age was not statistically significant (P0.05). Normal gestational age group for birth weight (2215 + 273g), appropriate for gestational age birth weight (2853 + 291G), the difference was statistically significant (P0.01). Each group between birth weight were statistically significant (P0.05).2. normal gestational age of mothers of gestational age the mother of hypertensive disorder complicating pregnancy, multiple pregnancy, abortion, placenta and umbilical cord abnormal rate was higher than the average for gestational age, the difference was statistically significant (P0.05). The term SGA and AGA mother mother in cholestasis, the smoking is no difference (P0.05).3. during hospitalization General term SGA and aga in return to birth weight, weight loss percentage was not statistically significant (P0.05). The term SGA oral feeding time, parenteral nutrition time were longer than appropriate for gestational age, the difference was statistically significant (P0.05). The term is less than the Fed intolerance, infection, gestational age, polycythemia is higher than the proportion of appropriate for gestational age, the difference was statistically significant (P0.05).4. were cerebral function monitoring results of group 1 aEEG showed no obvious difference between graphic continuity, sleep cycle, wave band width; group 2A EEG newborns showed continuity less visible graphics, sleep cycle, spectrum band width slightly wider; 3 a in group EEG showed continuous better graphics, easy to identify the sleep cycle, with narrow spectrum; group 4 a EEG showed continuous graphics, mature sleep cycle, with a narrow width Spectral Group 1. , group 2, group 3, group 4 in the continuous score, sleep cycle score, lower boundary score, width score, total score comparison, the differences were statistically significant (P0.001). The 1 groups of neonatal continuous score, sleep cycle score, lower boundary score, total width score, score was significantly lower than that of group 2, group the 3 and 4 group, and the difference was statistically significant (P0.05). The 2 groups of neonatal continuous score, sleep cycle score, lower boundary score, total width score, score was significantly lower than that of group 3 and group 4, and the difference was statistically significant (P0.05). The 3 groups of neonatal continuous score, sleep cycle score, lower boundary the width of the total score, score, score was significantly lower than that of group 4, and the difference was statistically significant (P0.05). Conclusion: 1. hypertensive disorders of pregnancy, multiple pregnancy, abortion, placenta and umbilical cord abnormalities are risk factors of.2. in term of term small for gestational age infant gestational age hospitalized during oral feeding time, 鑲犲�栬惀鍏绘椂闂存椂闀胯緝闀�,涓旀洿瀹规槗鍑虹幇鍠傚吇涓嶈，

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