轻度脑室周围—脑室内出血和重度脑室旁白质损伤对早产儿排尿方式影响的研究
发布时间：2019-06-19 12:22
【摘要】：随着新生儿诊疗技术的发展，早产儿存活率有了很大的提高，早产儿疾病也越来越引起了人们的重视。脑损伤是早产儿常见的神经系统疾病，有很多表现形式，其中脑室周围-脑室内出血（Peri-intraventricular hemorrhage,PIVH)和脑室旁白质损伤(Periventricular White Matter Injury, PWMI)是早产儿脑损伤最为常见的类型。当前对这两种脑损伤的研究主要局限在为发病机制，诊断治疗及预后方面，这两种脑损伤对早产儿排尿方式影响的研究尚未多见，有待探讨。 排尿是一个复杂的神经反射过程，需要位于脊髓腰骶部的低级排尿中枢和位于脊髓以上的高级排尿中枢共同参与完成，脊髓以上控制排尿的高级神经中枢主要包括脑桥储尿和排尿中枢，中脑水管周围灰质，丘脑及大脑皮质的若干区域等，这些部位间存在着广泛的神经纤维联系。脑功能成像研究发现成人排尿时上诉这些部位的活动显著增强，提示高级神经系统调节成人排尿反射的整个过程。脑损伤对成人排尿的影响是显著的，脑血管疾病如脑梗塞及脑出血多会引起成人排尿方式的改变，如出现尿频，尿急等。脑室旁白质损伤的成年患者多合并有显著的膀胱功能障碍，提示脑室旁白质也在排尿反射中发挥重要作用。 新生儿排尿特点主要包括排尿次数多，每次尿量少，排尿后存在残余尿，间断排尿，睡眠中排尿等。对足月儿的自由排尿观察发现足月儿在排尿时存在明显的觉醒征象如从睡眠中醒来，肢体活动等，脑电图检查显示足月儿在排尿时有脑电波的改变，提示大脑皮质及高级神经中枢已参与了足月儿的排尿反射。对早产儿的自由排尿观察发现早产儿排尿时只有部分存在觉醒征象，多数排尿发生在睡眠时，脑电图检查显示早产儿在排尿时脑电波并未发生明显改变，提示相对足月儿排尿，早产儿排尿表现得更为不成熟，高级神经中枢在早产儿排尿反射中发挥的作用还有待探讨。 早产儿脑室周围-脑室内出血的出血部位位于侧脑室腹外侧尾状核头部，临近多个脊髓以上高级排尿中枢，可通过多种形式对这些排尿中枢产生影响，轻度出血多不伴有脑室扩张，而重度出血多伴有脑室扩张，重度出血患儿病情为重，所以未纳入本研究。根据颅脑超声检查脑室旁强回声的持续时间，可将早产儿脑室旁白质损伤分为轻度损伤，强回声持续时间少于7天和重度损伤，强回声持续时间多于14天，重度脑室旁白质损伤更能反映高级神经中枢在早产儿排尿反射中发挥的作用。 本研究对胎龄32-36周轻度脑室周围-脑室内出血早产儿，，重度脑室旁白质损伤早产儿及正常早产儿实施了连续8小时自由排尿观察并收集多项排尿参数，通过比较轻度脑室周围-脑室内出血早产儿与正常早产儿，重度脑室旁白质损伤早产儿与正常早产儿排尿参数的差异，发现这两种形式的脑损伤对早产儿排尿方式的影响是显著的，提示高级神经中枢已参与了胎龄较大早产儿的排尿反射活动。 目的： 探讨轻度脑室周围-脑室内出血（PIVH）和重度脑室旁白质损伤（PWMI）对早产儿排尿方式的影响。 方法： 本研究包括55例胎龄在32-35周适于胎龄早产儿，均在出生后2-7天内行颅脑超声检查，根据是否发现轻度PIVH或重度PWMI将其分为轻度PIVH组（20例），重度PWMI组（19例）和正常组（16例），对轻度PIVH组，重度PWMI组和正常组早产儿在其出生后日龄为9-15天时进行连续8小时自由排尿观察，记录每位早产儿的排尿次数，每次排尿量，残余尿量，清醒排尿及间断排尿，通过统计学软件比较轻度PIVH早产儿和正常早产儿排尿参数以及重度PWMI早产儿和正常早产儿排尿参数有无差异。 结果： 轻度PIVH组早产儿膀胱排空比例((26±11)%vs.(34±7)%,P=0.02)，清醒排尿比例((34±11)%vs.(42±7)%,P=0.01)显著低于正常组早产儿，残余尿量((P25=0ml.,P50=2ml.,P75=3ml.)vs.(P25=0ml.,P50=2ml.,P75=2ml.),P=0.02)显著高于正常组早产儿，轻度PIVH组与正常组早产儿在排尿次数(（6.6±1.1）vs.(7.0±1.1),P=0.29)，每次排尿量((16.4±5.4)ml.vs.(15.9±5.3)ml.,P=0.43)及间断排尿(50%vs.44%,P=0.75)比例方面无显著性差异。 重度PWMI组早产儿排尿次数((5.1±1.0)vs.(7.0±1.1), P0.01),清醒排尿比例(23±11)%vs.(42±7)%,P0.01)及排空排尿比例((P25=16%,P50=20%,P75=28%)vs.(P25=28%,P50=33%,P75=40%),P0.01)显著低于正常组早产儿，每次排尿量(19.9±6.6)ml.vs.(15.9±5.3)ml.,P0.01）及残余尿量（(P25=1ml.,P50=3ml.,P75=3ml.）vs.(P25=0ml.,P50=2ml.,P75=2ml.),P0.01)显著高于正常组早产儿，重度PWMI组与正常组的间断排尿比例(52%vs.44%, P=0.74)无显著性差异。 结论： 1.轻度PIVH对胎龄较大早产儿排尿时的意识状态及膀胱排空具有显著影响。 2.重度PWMI对胎龄较大早产儿整体排尿方式具有显著影响，主要表现为排尿次数减少及每次排尿量增多。 3.高级神经中枢已参与了胎龄较大早产儿的排尿反射。 4.脑干以上高级神经中枢对胎龄较大早产儿排尿反射发挥易化作用。
[Abstract]:With the development of the newborn's diagnosis and treatment technology, the survival rate of the premature infant is greatly improved, and the premature infant's disease has become more and more important. Brain injury is a common nervous system disease in premature infants. There are many manifestations, in which the periventricular-intraventricular hemorrhage (PIVH) and the periventricular white matter (PWMI) are the most common types of brain damage in premature infants. The current research on these two kinds of brain damage is mainly limited to the pathogenesis, diagnosis and treatment and the prognosis. Urination is a complex process of neuroreflection, which is required to be located in the low-level micturition center of the lumbar spinal part of the spinal cord and the high-level micturition center above the spinal cord. The high-level nerve center for controlling urination above the spinal cord mainly includes the brain-bridge urine storage and the urination. A number of areas, such as the periaqueductal gray matter, the thalamus, and the cerebral cortex. System. The brain functional imaging study found that the activity of these sites was significantly enhanced in adult urination, suggesting that the high-level nervous system regulates the whole of the adult micturition reflex Cheng. The effect of brain injury on the urination of adults is significant. The cerebrovascular disease, such as cerebral infarction and cerebral hemorrhage, can cause the change of the adult micturition, such as the occurrence of frequent micturition and urgency. In adult patients with periventricular leukaiosis, there are significant bladder dysfunction, suggesting that the periventricular white matter also plays an important role in the reflex of micturition. The characteristics of urination in the newborn mainly include more frequent urination, less urine volume, residual urine after urination, intermittent urination, and sleep. Urination and the like. The free micturition of the foot of the foot is found to have obvious wakefulness in urination, such as waking up from the sleep, limb activity, etc., and the electroencephalogram examination shows that the baby's brain wave has a brain wave during urination. The changes of the cerebral cortex and the high-level nerve center have been involved in the row of the foot-moon. Urine reflex. The free micturition of premature infants showed that only a part of the premature infants had an awakening sign, most of the micturition occurred in the sleep, and the EEG examination showed that the brain waves did not change significantly at the time of urination, indicating the relative foot-months. The effect of urination and urination in premature infants is more immature, and the high-level nerve center plays an important role in the reflex of urination in premature infants. To be discussed. The bleeding part of the periventricular-intraventricular hemorrhage of the premature infant is located in the head of the lateral lateral caudate nucleus of the lateral ventricle. It is close to the high-grade micturition center of the multiple spinal cord. It can have the effect on these micturition centers in a variety of forms. The ventricle is dilated, and the severe bleeding is accompanied by ventricular dilatation, and the condition of the child with severe bleeding is heavy, so it is not It is included in this study. The periventricular leukaiosis of premature infants can be divided into mild lesions, a strong echo duration of less than 7 days and a severe injury, a strong echo duration, More than 14 days, severe intraventricular white matter damage can reflect the high-level nerve center in the early-term micturition reflex of premature infants The effect of this study on premature and severe intraventricular hemorrhage of premature and severe intraventricular leukaiosis in the 32-36 weeks of fetal age was observed and received in a continuous 8-hour free-micturition. The effect of these two forms of brain injury on the urination of premature infants was found by comparing the difference between the early and normal preterm infants, the severe intraventricular leukaiosis, and the normal prematurity of premature infants. The effect is significant, suggesting that the high-level nerve center has been involved in the older preterm infants. micturition Reflex activity. Objective: To investigate the periventricular hemorrhage (PIVH) and the severe ventricular leukaiosis (PWMI) in the periventricular-intraventricular hemorrhage (PIVH). prematurity Methods: The study included 55 cases of premature infants with gestational age of 32-35 weeks, all of which underwent a head-and-brain ultrasound examination within 2-7 days after birth, and it was divided into mild PIVH group (20 cases), severe PWMI group (19 cases) and normal group according to whether mild PIVH or severe PWMI was found. The group (16 cases), treated with mild PIVH group, severe PWMI group and normal group of premature infants at the age of 9-15 days after birth for 8 hours to observe, record the number of micturition of each premature infant, each time the amount of urination , residual urine volume, awake urination, and intermittent urination, comparing mild PIVH premature and normal preterm infant urination parameters with statistical software, and severe PWMI preterm birth Er and Zheng The results showed that the ratio of urinary bladder emptying (26%11)% vs. (34%7)%, P = 0.02), and the ratio of conscious micturition (34%11)% vs. (42%7)%, P = 0.01) were significantly lower than that of positive prematurity. normal group of premature infants, residual urine Quantity (P25 = 0 m l.,P50=2ml.,P 75=3ml.)v s.(P25=0m L., P50 = 2 ml., P75 = 2 ml.), P = 0.02) was significantly higher in the normal group than in the normal group, and the number of micturition (6.6% 1.1) vs. (7.0% 1.1) vs. (7.0% 1.1), P = 0.29) in the mild PIH group and the normal group, each time (16.4% 5.4)
本文编号：2502345
[Abstract]:With the development of the newborn's diagnosis and treatment technology, the survival rate of the premature infant is greatly improved, and the premature infant's disease has become more and more important. Brain injury is a common nervous system disease in premature infants. There are many manifestations, in which the periventricular-intraventricular hemorrhage (PIVH) and the periventricular white matter (PWMI) are the most common types of brain damage in premature infants. The current research on these two kinds of brain damage is mainly limited to the pathogenesis, diagnosis and treatment and the prognosis. Urination is a complex process of neuroreflection, which is required to be located in the low-level micturition center of the lumbar spinal part of the spinal cord and the high-level micturition center above the spinal cord. The high-level nerve center for controlling urination above the spinal cord mainly includes the brain-bridge urine storage and the urination. A number of areas, such as the periaqueductal gray matter, the thalamus, and the cerebral cortex. System. The brain functional imaging study found that the activity of these sites was significantly enhanced in adult urination, suggesting that the high-level nervous system regulates the whole of the adult micturition reflex Cheng. The effect of brain injury on the urination of adults is significant. The cerebrovascular disease, such as cerebral infarction and cerebral hemorrhage, can cause the change of the adult micturition, such as the occurrence of frequent micturition and urgency. In adult patients with periventricular leukaiosis, there are significant bladder dysfunction, suggesting that the periventricular white matter also plays an important role in the reflex of micturition. The characteristics of urination in the newborn mainly include more frequent urination, less urine volume, residual urine after urination, intermittent urination, and sleep. Urination and the like. The free micturition of the foot of the foot is found to have obvious wakefulness in urination, such as waking up from the sleep, limb activity, etc., and the electroencephalogram examination shows that the baby's brain wave has a brain wave during urination. The changes of the cerebral cortex and the high-level nerve center have been involved in the row of the foot-moon. Urine reflex. The free micturition of premature infants showed that only a part of the premature infants had an awakening sign, most of the micturition occurred in the sleep, and the EEG examination showed that the brain waves did not change significantly at the time of urination, indicating the relative foot-months. The effect of urination and urination in premature infants is more immature, and the high-level nerve center plays an important role in the reflex of urination in premature infants. To be discussed. The bleeding part of the periventricular-intraventricular hemorrhage of the premature infant is located in the head of the lateral lateral caudate nucleus of the lateral ventricle. It is close to the high-grade micturition center of the multiple spinal cord. It can have the effect on these micturition centers in a variety of forms. The ventricle is dilated, and the severe bleeding is accompanied by ventricular dilatation, and the condition of the child with severe bleeding is heavy, so it is not It is included in this study. The periventricular leukaiosis of premature infants can be divided into mild lesions, a strong echo duration of less than 7 days and a severe injury, a strong echo duration, More than 14 days, severe intraventricular white matter damage can reflect the high-level nerve center in the early-term micturition reflex of premature infants The effect of this study on premature and severe intraventricular hemorrhage of premature and severe intraventricular leukaiosis in the 32-36 weeks of fetal age was observed and received in a continuous 8-hour free-micturition. The effect of these two forms of brain injury on the urination of premature infants was found by comparing the difference between the early and normal preterm infants, the severe intraventricular leukaiosis, and the normal prematurity of premature infants. The effect is significant, suggesting that the high-level nerve center has been involved in the older preterm infants. micturition Reflex activity. Objective: To investigate the periventricular hemorrhage (PIVH) and the severe ventricular leukaiosis (PWMI) in the periventricular-intraventricular hemorrhage (PIVH). prematurity Methods: The study included 55 cases of premature infants with gestational age of 32-35 weeks, all of which underwent a head-and-brain ultrasound examination within 2-7 days after birth, and it was divided into mild PIVH group (20 cases), severe PWMI group (19 cases) and normal group according to whether mild PIVH or severe PWMI was found. The group (16 cases), treated with mild PIVH group, severe PWMI group and normal group of premature infants at the age of 9-15 days after birth for 8 hours to observe, record the number of micturition of each premature infant, each time the amount of urination , residual urine volume, awake urination, and intermittent urination, comparing mild PIVH premature and normal preterm infant urination parameters with statistical software, and severe PWMI preterm birth Er and Zheng The results showed that the ratio of urinary bladder emptying (26%11)% vs. (34%7)%, P = 0.02), and the ratio of conscious micturition (34%11)% vs. (42%7)%, P = 0.01) were significantly lower than that of positive prematurity. normal group of premature infants, residual urine Quantity (P25 = 0 m l.,P50=2ml.,P 75=3ml.)v s.(P25=0m L., P50 = 2 ml., P75 = 2 ml.), P = 0.02) was significantly higher in the normal group than in the normal group, and the number of micturition (6.6% 1.1) vs. (7.0% 1.1) vs. (7.0% 1.1), P = 0.29) in the mild PIH group and the normal group, each time (16.4% 5.4)
ml. vs. . (15.9-5.3) ml., P = 0.43) and intermittent urination (50% vs.44 There was no significant difference in the ratio of%, P = 0.75. The number of micturition of premature infants in the severe PWMI group ((5.1% 1.0) vs. (7.0% 1.1), P 0.01), the ratio of clear urination (23%11)% vs. (42%7)%, P 0.01) and the proportion of emptying (P25 = 16%, P50 = 20%, P75 = 28%) vs. (P25 (= 28%, P50 = 33%, P75 = 40%), P 0.01) was significantly lower than that of the normal group, each time the amount of urine (19.9% 6.6)
ml. Vs. (15.9卤5.3)ml. (P0.01) and disabled Remaining urine volume (P25 = 1ml.,P50=3ml. ,P75=3ml. )vs.(P25= 0 ml., P50 = 2 ml., P75 = 2 ml.), P 0.01) was significantly higher than that of the normal group of premature, severe PWMI and normal groups (52 %vs (44%, P = 0.74) no significant difference. Conclusion:1. Mild PIVH vs. 2. The effect of severe PWMI on the whole micturition of premature infants with large gestational age The formula has a remarkable effect, and is mainly characterized in that the number of micturition is reduced and the amount of urine is discharged each time 3. The high-level nerve center has been involved in the micturition reflex of the older preterm infants.
【学位授予单位】：郑州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R722.6
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