【摘要】：背景新生兒低血糖癥是新生兒期常見的代謝性疾病之一,持續(xù)或反復(fù)低血糖可能導(dǎo)致嚴(yán)重腦損傷,甚至癲癇、運(yùn)動或認(rèn)知障礙、腦癱等中樞神經(jīng)系統(tǒng)后遺癥。由于臨床表現(xiàn)不典型,在臨床實(shí)際工作中未引起基層及臨床一線醫(yī)務(wù)人員足夠的重視。低血糖腦損傷的發(fā)生受多種因素影響,如窒息、黃疸、胎膜早破、母親妊娠期糖尿病等,近些年來產(chǎn)前糖皮質(zhì)激素應(yīng)用預(yù)防新生兒呼吸窘迫綜合征(neonatal respiratory distress syndrome,NRDS)已被證實(shí)有確切效果,但目前臨床應(yīng)用仍很不足;產(chǎn)前糖皮質(zhì)激素應(yīng)用對新生兒血糖的影響報道甚少,對新生兒低血糖及新生兒低血糖腦損傷的影響未見報道;頭顱核磁共振對診斷新生兒低血糖腦損傷意義重大,但頭顱核磁共振成像(magnetic resonance imaging,MRI)的表現(xiàn)與患兒預(yù)后的關(guān)系尚不明確,需進(jìn)一步研究探討。目的1.分析新生兒低血糖腦損傷(neonatal hypoglycemia brain injury,NHBI)的相關(guān)影響因素,探討產(chǎn)前糖皮質(zhì)激素應(yīng)用對NHBI的價值;2.探討新生兒低血糖腦損傷患兒頭顱MRI改變及其與預(yù)后的關(guān)系。方法采用回顧性研究方法,選取新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院新生兒重癥監(jiān)護(hù)室及新生兒科2015年1月至2016年12月期間診斷明確的新生兒低血糖病例85例,其中診斷為新生兒低血糖腦損傷36例,無低血糖腦損傷49例,分組分析新生兒低血糖腦損傷可能影響因素,產(chǎn)前糖皮質(zhì)激素應(yīng)用對新生兒低血糖腦損傷存在的價值。應(yīng)用美國IBM公司開發(fā)的SPSS21.0統(tǒng)計軟件給予統(tǒng)計分析,計量資料符合正態(tài)性分布進(jìn)行t檢驗,以均數(shù)±標(biāo)準(zhǔn)差((?)±S)表示,不符合正態(tài)分布的以中位數(shù)表示,組間比較采用Mann-Whitney U檢驗;計數(shù)資料采用百分比(%)、卡方檢驗,予單因素logistic回歸分析篩選,后予多因素的二元logistic回歸分析;P0.05表示差異有統(tǒng)計學(xué)意義。對診斷新生兒低血糖腦損傷頭顱核磁共振(MRI)資料的收集及對患兒的隨訪運(yùn)用描述性的方法予以分析。結(jié)果1.多因素的二元logistic回歸分析示開奶時間(P=0.019)、低血糖持續(xù)時間(P=0.000)、轉(zhuǎn)診來源(P=0.014)在新生兒低血糖腦損傷多因素分析中差異具有統(tǒng)計學(xué)意義;產(chǎn)前糖皮質(zhì)激素應(yīng)用對新生兒低血糖腦損傷影響的卡方檢驗顯示差異有統(tǒng)計學(xué)意義(P=0.000)2.新生兒低血糖腦損傷頭顱MRI信號變化位置、范圍,頭顱MRI信號出現(xiàn)異常持續(xù)時間與新生兒低血糖腦損傷后遺癥的發(fā)生關(guān)系密切,頭顱MRI信號改變范圍越大、持續(xù)異常時間越長后遺癥表現(xiàn)越明顯。結(jié)論1.新生兒低血糖腦損傷受多種因素影響,開奶時間、低血糖持續(xù)時間、轉(zhuǎn)診來源是其獨(dú)立危險因素;2.產(chǎn)前糖皮質(zhì)激素應(yīng)用能減少低血糖腦損傷的發(fā)病率;適用范圍內(nèi)(預(yù)防NRDS)大力推廣意義重大。3.頭顱MRI的應(yīng)用對新生兒低血糖腦損傷診斷有重要意義,尤其在早期診斷方面彌散加權(quán)成像(diffusion weighted imaging,DWI)優(yōu)勢明顯;對新生兒低血糖腦損傷的預(yù)后有一定的判斷價值。
[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 鹵standard deviation (?) 鹵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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R722.1

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