發(fā)布時間：2018-03-03 06:05

  本文選題：足月小于胎齡兒　切入點(diǎn)：宮內(nèi)發(fā)育遲緩　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的宮內(nèi)發(fā)育遲緩對足月新生兒腦功能成熟度的影響;探討不同出生體重對足月小于胎齡兒腦成熟度的影響。方法將納入研究的足月小于胎齡兒按體重百分位數(shù)分3組,即體重小于第3百分位數(shù)組、體重介于第3百分位數(shù)和第5百分位數(shù)組、體重大于第5百分位數(shù)組,分別定義為組1、組2、組3,同期選取足月適于胎齡兒做對照,即適于胎齡兒組,定義為組4,每組各35例。所有新生兒均在家屬知情同意下于出生后72小時內(nèi)進(jìn)行a EEG的監(jiān)測,每次至少監(jiān)測2小時,同時記錄患兒住院期間的一般情況。對所有患兒的a EEG監(jiān)測結(jié)果,采用腦功能監(jiān)測評分系統(tǒng)對連續(xù)性、睡眠周期、下邊界及寬度分別進(jìn)行評分,并計(jì)算總評分,比較各組新生兒腦功能發(fā)育情況。結(jié)果1.10 min Apgar評分、出生胎齡、體重比較足月小于胎齡兒組(組1、組2、組3)與適于胎齡兒組(組4)10 min Apgar評分、出生胎齡比較無統(tǒng)計(jì)學(xué)意義(P0.05)。足月小于胎齡兒組出生體重為(2215±273g),適于胎齡兒組出生體重為(2853±291g),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。各組間出生體重比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。2.足月小于胎齡兒母親產(chǎn)科情況小于胎齡兒母親妊娠期高血壓疾病、多胎妊娠、流產(chǎn)史、胎盤臍帶異常的發(fā)生率高于適于胎齡兒,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。足月小于胎齡兒母親與適于胎齡兒母親在膽汁淤積癥、吸煙方面的比較沒有差異(P0.05)。3.住院期間一般情況足月小于胎齡兒與適于胎齡兒在恢復(fù)至出生體重時長、體重最大下降百分比的比較無統(tǒng)計(jì)學(xué)意義(P0.05)。足月小于胎齡兒口飼時間、腸外營養(yǎng)時間均長于適于胎齡兒,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。足月小于胎齡兒中出現(xiàn)喂養(yǎng)不耐受、感染、紅細(xì)胞增多癥的比例高于適于胎齡兒,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.各組腦功能監(jiān)測結(jié)果組1 aEEG表現(xiàn)為連續(xù)性差圖形、未見明顯睡眠周期、波譜帶寬度寬;組2a EEG新生兒表現(xiàn)為連續(xù)性稍差圖形、可見睡眠周期、波譜帶寬度稍寬;組3 a EEG表現(xiàn)為連續(xù)性漸好圖形、易辨認(rèn)睡眠周期、波譜帶寬度窄;組4 a EEG表現(xiàn)為連續(xù)性圖形、成熟的睡眠周期、波譜帶寬度窄。組1、組2、組3、組4在連續(xù)性評分、睡眠周期評分、下邊界評分、寬度評分、總評分方面比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。組1新生兒連續(xù)性評分、睡眠周期評分、下邊界評分、寬度評分、總評分明顯低于組2、組3和組4,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。組2新生兒連續(xù)性評分、睡眠周期評分、下邊界評分、寬度評分、總評分明顯低于組3和組4,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。組3新生兒連續(xù)性評分、睡眠周期評分、下邊界評分、寬度評分、總評分明顯低于組4,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.母親妊娠期高血壓疾病、多胎妊娠、流產(chǎn)史、胎盤臍帶異常是足月小于胎齡兒發(fā)生的危險因素。2.足月小于胎齡兒住院期間口飼時間、腸外營養(yǎng)時間時長較長,且更容易出現(xiàn)喂養(yǎng)不耐受、感染、紅細(xì)胞增多癥等并發(fā)癥。3.足月小于胎齡兒腦成熟度落后于適于胎齡兒,而且腦成熟度與出生體重百分位數(shù)具有相關(guān)性,即足月小于胎齡兒出生體重百分位數(shù)越小,腦功能越不成熟。4.a EEG監(jiān)測能夠評估足月小于胎齡兒腦成熟度,具有良好的臨床價值。
[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钀ュ吇鏃墮棿鏃墮暱杈冮暱,涓旀洿瀹規(guī)槗鍑虹幇鍠傚吇涓嶈，

本文編號：1559818