>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
窒息早产儿有核红细胞变化与缺氧性脑损害的相关性研究
作者:姬静璐  李少华  李朝英  王玉  魏继红  孙东明  杨小巍 
单位:河北大学附属医院 儿科, 河北 保定 071000
关键词:窒息 早产儿 红细胞参数变化 缺氧性脑损伤 
分类号:R722.6
出版年·卷·期(页码):2019·38·第一期(140-144)
摘要:

目的:探讨窒息对早产儿血常规中红细胞参数的影响,以及有核红细胞(NRBC)在窒息早产儿中是否具有预测早产儿缺氧性脑损伤程度及预后的作用。方法:选择2015年6月至2017年5月入住我院新生儿科的窒息早产儿伴脑损伤的为观察组(n=50,MRI确认),窒息早产儿无脑损伤组(n=30),无窒息早产儿20例为对照组(n=20)。三组患儿均在生后的不同时间点进行血常规红细胞参数检测、MRI、振幅整合脑电图和头颅彩色多普勒检查。动态观察窒息早产儿脑损害预后情况。结果:观察组与对照组相比较,红细胞总数(RBC)、HGB、HCT差异无统计学意义(P>0.05);观察组NRBC及NRBC%显著高于对照组(P<0.05);振幅整合脑电图EEG连续性(Co)、睡眠觉醒周期(Cy)和下边缘振幅值(LB)显著低于对照组(P<0.05),观察组脑血流速度显著低于对照组(P<0.05),NRBC参数在窒息早产儿出生后12个月基本恢复正常(P<0.05),脑损伤发生百分率显著下降(P<0.05),NRBC升高程度与窒息程度成正相关。结论:窒息早产儿初生血常规红细胞参数NRBC升高程度与窒息程度成相关;窒息早产儿NRBC恢复正常的时间与头颅影像学及脑电图异常恢复时间成正相关,可以作为预测脑损伤程度及预后的评估指标。

Objective:To investigate the effect of asphyxia on erythrocyte parameters in preterm infants, and whether nucleated red blood cells (NRBC) can predict hypoxic brain damage and prognosis in premature infants. Methods:Fifity asphyxia premature infants with brain injury and 30 asphyxia premature infants without brain injury were selected as observation group, and 20 preterm infants as control group from June 2015 to May 2017. Blood routine red blood cell parameters were detected at different time points in the two groups. We also had MRI, amplitude integrated electroencephalogram and head color Doppler examination. The brain damage in preterm infants was observed dynamically. Results:The number of red blood cells (RBC), HGB, HCT had no statistical significance between the observation group and the control group (P>0.05). NRBC and NRBC% of the observation group were significantly higher than that in the control group (P<0.05); Amplitude integrated electroencephalogram (Co) EEG continuity, sleep wake cycle (Cy) and edge amplitude (LB) of the observation group were significantly lower than the control group (P<0.05). The cerebral blood flow velocity of the observation group was significantly lower than that of the control group (P<0.05). The NRBC parameters returned to normal in 12 months after birth, and the percentage of brain injury decreased significantly (P<0.05). The increase of NRBC was positively correlated with the degree of asphyxia. The level of NRBC was positively correlated with the degree of asphyxia preterm infants. Conclusion:The degree of NRBC elevation in asphyxiated premature infants is associated with the degree of asphyxia. The time of NRBC returned to normal in asphyxia premature infants is positively correlated with the recovery time of cranial imaging and EEG abnormality. It can be used as an index to predict the degree and prognosis of brain injury.

参考文献:

[1] FOTTRELL E,OSRIN D,ALCOCK G,et al.Cause-specific neonatal mortality:analysis of 3772 neonatal deaths in Nepal,Bangladesh,Malawi and India[J].Arch Dis Child Fetal Neonatal Ed,2015,100(5):F439-F447.
[2] JBRYCE J,BOSCHIPINTO C,SHIBUYA K,et al.WHO estimates of the causes of death in children[J].The Lancet,2005,365(9465):1147-1152.
[3] LINCETTO O,WHO Geneve.Birth asphyxia-summary of the previous meeting and protocol overview[C].Milano,2007.
[4] 中国医师协会新生儿专业委员会.新生儿窒息诊断和分度标准建议[J].中国当代儿科杂志,2013,15(1):1.
[5] MORALES P,BUSTAMANTE D,ESPINA-MARCHANT P,et al.Pathophysiology of perinatal asphyxia:can we predict and improve individual outcomes?[J].EPMA J,2011,2(2):211-230.
[6] 郝玲,邓彦东,王娜,等.窒息早产儿脑血流变化及其与脑损伤的关系[J].中国妇幼保健,2013,28(24):3938-3940.
[7] BURDJALOV V F,BAUMGART S,SPITZSER A R.Cerebral function monitoring:A new system for the evaluation of brain maturation in neonates[J].Pediatrics,2003,112(4):855-861.
[8] 孟淑英,张可冰.有核红细胞预测缺氧缺血性脑病严重程度和预后的价值[J].中国小儿急救医学,2013,20(2):186-187.
[9] 谢露,陈洪清,杨尧,等.有核红细胞预测围产期窒息严重度和短期预后的价值[J].中华临床医师杂志:电子版,2011,5(23):7140-7143.
[10] SARNAT H B,SARNAT M S.Neonatal encephalopathy following fetal distress.A clinical and electroencephalographic study[J].Arch Neurol,1976,33(10):696-705.
[11] ROBERTSON C M,PERLMAN M.Follow-up of the term infant after hypoxic-ischemic encephalopathy[J].Paediatr Child Health,11(5):278-282.
[12] 李春亮,劳晓玲,莫洁洁,等.围产期窒息新生儿严重高乳酸血症快速清除治疗研究[J].临床医学,2016,12(36):44-46.
[13] MEMON S,SHAIKH S,BIBI S.To compare the outcome(early)of neonates with birth asphyxia in-relation to place of delivery and age at time of admission[J].J Pak Med Assoc,2012,62(12):1277-1281.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 250589 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364