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目的应用三维超声技术探讨早产儿脑额叶发育及其影响因素。方法选取222例无严重脑损伤的早产儿,应用三维超声对额叶体积进行测量。随访中分别在矫正年龄至40周、1个月、3个月、6个月及以后的时间进行全面的神经系统及体格发育检查,6个月内进行体积跟踪测定。结果早产儿出生时额叶体积随胎龄的增加而增长。生后出现追赶性生长,在矫正年龄40周及1个月时增长最为迅速,达到甚至超过了足月儿,在以后的生长中逐渐落后于正常足月儿。早产儿成熟度越低,额叶体积越小,矫正年龄40周及以后的时间点,各组额叶体积数值相当,组间差异无统计学意义(P>0.05)。宫内外营养情况较差的早产儿额叶体积的生长始终落后于生长发育正常的早产儿(P<0.05)。额叶体积生长严重落后的早产儿出现神经发育重度异常的几率较正常早产儿明显升高(50%)。结论早产儿额叶体积随胎龄增长而增加,生后短期内出现追赶性生长,宫内外营养状况影响额叶发育,体积测定值的异常与神经发育异常有关。
Objective To explore the frontal lobe development and its influencing factors in preterm infants by three-dimensional ultrasonography. Methods Totally 222 premature infants without severe brain injury were selected. The frontal lobe volume was measured by three-dimensional ultrasonography. Follow-up in the correction of age to 40 weeks, 1 month, 3 months, 6 months and beyond a comprehensive examination of the nervous system and physical development, volume tracking within 6 months. Results The volume of the frontal lobe at birth increased with gestational age. After birth, there was catch-up growth, with the fastest growth at 40 weeks and 1 month of correction, reaching or even surpassing that of full-term children and gradually lagging behind normal full-term children in later growth. The lower the maturity of premature infants, the smaller the volume of frontal lobe, the corrective age of 40 weeks and beyond, the frontal lobe volume of each group is equal, with no significant difference between groups (P> 0.05). The growth of the frontal lobe volume of premature infants with poor intrauterine and uterus nutrition status lagged behind that of the normal growth and development of preterm infants (P <0.05). Preterm infants with severely delayed frontal volume growth have significantly higher rates of neurodevelopmental dysfunction than their normal counterparts (50%). Conclusion The frontal lobe volume of premature infants increases with the increase of gestational age, and there is catch-up growth in the short term after birth. The nutritional status in the uterus and forelimb affects the development of the frontal lobe. The abnormality of the measured volume values is related to abnormal neurodevelopment.