新生儿低血糖脑损伤风险因素分析及随访研究

发布时间：2018-10-05 14:43

【摘要】：背景新生儿低血糖症是新生儿期常见的代谢性疾病之一,持续或反复低血糖可能导致严重脑损伤,甚至癫痫、运动或认知障碍、脑瘫等中枢神经系统后遗症。由于临床表现不典型,在临床实际工作中未引起基层及临床一线医务人员足够的重视。低血糖脑损伤的发生受多种因素影响,如窒息、黄疸、胎膜早破、母亲妊娠期糖尿病等,近些年来产前糖皮质激素应用预防新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)已被证实有确切效果,但目前临床应用仍很不足;产前糖皮质激素应用对新生儿血糖的影响报道甚少,对新生儿低血糖及新生儿低血糖脑损伤的影响未见报道;头颅核磁共振对诊断新生儿低血糖脑损伤意义重大,但头颅核磁共振成像(magnetic resonance imaging,MRI)的表现与患儿预后的关系尚不明确,需进一步研究探讨。目的1.分析新生儿低血糖脑损伤(neonatal hypoglycemia brain injury,NHBI)的相关影响因素,探讨产前糖皮质激素应用对NHBI的价值;2.探讨新生儿低血糖脑损伤患儿头颅MRI改变及其与预后的关系。方法采用回顾性研究方法,选取新乡医学院第一附属医院新生儿重症监护室及新生儿科2015年1月至2016年12月期间诊断明确的新生儿低血糖病例85例,其中诊断为新生儿低血糖脑损伤36例,无低血糖脑损伤49例,分组分析新生儿低血糖脑损伤可能影响因素,产前糖皮质激素应用对新生儿低血糖脑损伤存在的价值。应用美国IBM公司开发的SPSS21.0统计软件给予统计分析,计量资料符合正态性分布进行t检验,以均数±标准差((?)±S)表示,不符合正态分布的以中位数表示,组间比较采用Mann-Whitney U检验;计数资料采用百分比(%)、卡方检验,予单因素logistic回归分析筛选,后予多因素的二元logistic回归分析;P0.05表示差异有统计学意义。对诊断新生儿低血糖脑损伤头颅核磁共振(MRI)资料的收集及对患儿的随访运用描述性的方法予以分析。结果1.多因素的二元logistic回归分析示开奶时间(P=0.019)、低血糖持续时间(P=0.000)、转诊来源(P=0.014)在新生儿低血糖脑损伤多因素分析中差异具有统计学意义;产前糖皮质激素应用对新生儿低血糖脑损伤影响的卡方检验显示差异有统计学意义(P=0.000)2.新生儿低血糖脑损伤头颅MRI信号变化位置、范围,头颅MRI信号出现异常持续时间与新生儿低血糖脑损伤后遗症的发生关系密切,头颅MRI信号改变范围越大、持续异常时间越长后遗症表现越明显。结论1.新生儿低血糖脑损伤受多种因素影响,开奶时间、低血糖持续时间、转诊来源是其独立危险因素;2.产前糖皮质激素应用能减少低血糖脑损伤的发病率;适用范围内(预防NRDS)大力推广意义重大。3.头颅MRI的应用对新生儿低血糖脑损伤诊断有重要意义,尤其在早期诊断方面弥散加权成像(diffusion weighted imaging,DWI)优势明显;对新生儿低血糖脑损伤的预后有一定的判断价值。
[Abstract]:Background hypoglycemia is one of the most common metabolic diseases in neonates. Persistent or repeated hypoglycemia may lead to severe brain damage, even epilepsy, motor or cognitive impairment, cerebral palsy and other central nervous system sequelae. Because the clinical manifestation is not typical, it has not caused enough attention of the primary and clinical medical personnel in the clinical practice. The occurrence of hypoglycemic brain injury is affected by many factors, such as asphyxia, jaundice, premature rupture of membranes, maternal gestational diabetes, etc. In recent years, the use of prenatal glucocorticoids in the prevention of neonatal respiratory distress syndrome (neonatal respiratory distress syndrome,NRDS) has been proved to have a definite effect, but the clinical application is still very insufficient, and the effect of prenatal glucocorticoid on neonatal blood sugar is rarely reported. The effect of cranial MRI on neonatal hypoglycemia and neonatal hypoglycemia brain injury was not reported, but the relationship between the manifestation of (magnetic resonance imaging,MRI and the prognosis of neonatal hypoglycemic brain injury was not clear. Further study is needed. Objective 1. To explore the value of prenatal glucocorticoid application in the treatment of neonatal hypoglycemic brain injury (neonatal hypoglycemia brain injury,NHBI). To investigate the changes of MRI and its relationship with prognosis in neonates with hypoglycemic brain injury. Methods A retrospective study was conducted to select 85 cases of neonatal hypoglycemia diagnosed between January 2015 and December 2016 in the neonatal intensive care unit of the first affiliated Hospital of Xinxiang Medical College and the neonatal pediatrics from January 2015 to December 2016. Among them, 36 cases were diagnosed as hypoglycemic brain injury, 49 cases without hypoglycemic brain injury. The possible influencing factors of neonatal hypoglycemic brain injury were analyzed. The value of prenatal application of glucocorticoid on neonatal hypoglycemic brain injury was analyzed. The statistical analysis was carried out by using the SPSS21.0 statistical software developed by IBM Company in the United States, and the measurement data according to the normal distribution were tested by t test, and the mean 卤standard deviation (?) 卤S) showed that the median was not in accordance with normal distribution, Mann-Whitney U test was used for inter-group comparison, percentage (%), chi-square test and single factor logistic regression analysis were used for counting data. Multivariate logistic regression analysis showed that the difference was statistically significant. Magnetic resonance imaging (MRI) data were collected in the diagnosis of hypoglycemic brain injury in neonates and were analyzed by descriptive method. Result 1. The multivariate logistic regression analysis showed that the time of milking (P0. 019), the duration of hypoglycemia (P0. 000), and the source of referral (P0. 014) were significantly different in multivariate analysis of neonatal hypoglycemic brain injury. The effect of prenatal glucocorticoid application on neonatal hypoglycemia brain injury showed significant difference (P0. 000) 2. The location, range and duration of abnormal MRI signal in the head of neonates with hypoglycemic brain injury were closely related to the sequelae of hypoglycemic brain injury. The larger the change range of MRI signal was, the larger the change range was. The longer the duration of the abnormality, the more obvious the sequelae were. Conclusion 1. Neonatal hypoglycemia brain injury is affected by many factors. The time of milking, duration of hypoglycemia and the source of referral are independent risk factors of neonatal hypoglycemia. Prenatal use of glucocorticoids can reduce the incidence of hypoglycemic brain injury. The application of cranial MRI has important significance in the diagnosis of neonatal hypoglycemic brain injury, especially in the early diagnosis of diffusion-weighted imaging (diffusion weighted imaging,DWI), and has certain value in judging the prognosis of neonatal hypoglycemic brain injury.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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