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目的探讨新生儿低血糖性脑损伤的临床特点及相关危险因素。方法选择本院2010年1月至2017年2月期间收治的低血糖症新生儿106例,积极处理患儿低血糖状态,根据核磁共振(MRI)、脑电图(EEG)等检查结果,将出现脑损伤的19例患儿纳入观察组,未出现脑损伤的87例患儿纳入对照组。观察记录低血糖性脑损伤患儿的临床表现,对性别、胎龄、新生儿体质量、分娩方式、妊娠期糖尿病、妊娠期高血压、新生儿窒息、病理性黄疸、首次哺乳时间、喂养困难、呼吸异常、肌张力降低、新生儿惊厥、意识异常、最低血糖水平、低血糖持续时间,EEG检查情况等可能影响低血糖新生儿脑损伤的因素进行单因素及多因素回归分析。结果研究中低血糖性脑损伤的发生率为17.9%,其主要临床表现为惊厥、呼吸异常、肌张力降低,MRI检查提示所有患儿损伤主要累及顶枕部皮层,扩散加权成像呈高信号,大多数T1W1呈低信号,T2W1呈高信号;EEG检查结果提示大多患儿出现异常改变,以局灶性阵发性棘波、电压平坦以及双侧半球间断低电压表现为主。经过单因素及多因素Logistic回归分析后得到孕妇合并妊娠期糖尿病、新生儿惊厥、血糖水平低于1.5 mmol/L、低血糖持续时间>24 h、EEG检查结果异常是影响新生儿低血糖性脑损伤的独立危险因素,差异均具有统计学意义(P<0.05)。结论新生儿血糖浓度过低、低血糖状态持续时间越长、新生儿惊厥发作、孕妇合并妊娠期糖尿病、EEG检查结果异常可能影响新生儿低血糖性脑损伤的发生,应加强监测并积极干预,降低新生儿脑损伤风险,避免神经系统损伤。
Objective To investigate the clinical features and related risk factors of neonatal hypoglycemic brain injury. Methods A total of 106 neonates with hypoglycemia admitted to our hospital from January 2010 to February 2017 were enrolled in this study. The hypoglycemic status of children was evaluated actively. According to the results of MRI and EEG, Twenty-nine children with brain injury were included in the observation group and 87 children without brain injury were included in the control group. Observe and record the clinical manifestations of children with hypoglycemic brain injury, sex, gestational age, neonatal body weight, mode of delivery, gestational diabetes, gestational hypertension, neonatal asphyxia, pathological jaundice, first lactation time, feeding difficulties , Respiratory abnormalities, hypotonia, neonatal convulsion, unconsciousness, the lowest blood glucose level, duration of hypoglycemia, EEG examination may affect the hypoglycemic neonatal brain injury factors univariate and multivariate regression analysis. Results The incidence of hypoglycemic brain injury in the study was 17.9%. The main clinical manifestations were convulsions, respiratory abnormalities and hypotonia. MRI examination showed that all the lesions in children mainly involved the top occipital cortex and diffusion-weighted imaging showed high signal, Most of T1W1 showed low signal and T2W1 showed high signal. The results of EEG examination showed that most of the patients had abnormal changes, with focal paroxysmal spikes, flat voltage and intermittent low voltage performance of bilateral hemispheres. After univariate and multivariate Logistic regression analysis, pregnant women with gestational diabetes mellitus, neonatal convulsions, blood glucose levels below 1.5 mmol / L, duration of hypoglycemia> 24 h, EEG abnormalities affect the neonatal hypoglycemic brain The independent risk factors of injury were statistically significant (P <0.05). Conclusion Neonatal hypoglycemia, hypoglycemic duration, neonatal seizures, pregnant women with gestational diabetes mellitus, abnormal EEG findings may affect the occurrence of neonatal hypoglycemic brain injury should be strengthened monitoring and active intervention, Reduce the risk of neonatal brain injury, to avoid nervous system damage.