胎儿生长受限抑制胎儿脑功能发育  

Adverse effects of fetal growth restriction on development of fetal cerebral function

作　　者：刘颖[1] 王华伟[1] 刘敬[2] 李静雅[2] 梁婧[2] 韩涛[2] 

机构地区：[1]安徽医科大学北京军区总医院临床学院附属八一儿童医院新生儿重症监护病房,北京100700 [2]北京军区总医院附属八一儿童医院新生儿重症监护病房

出　　处：《中华围产医学杂志》2014年第5期312-316,共5页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金（81170577）

摘　　要：目的 探讨胎儿生长受限对脑功能发育的影响. 方法 选择2012年8月1日至2013年2月28日在北京军区总医院附属八一儿童医院新生儿科住院、出生胎龄37～40＋6周的足月小于胎龄儿60例和适于胎龄儿40例.2组新生儿均无出生时窒息史,并除外惊厥、颅内出血、脑室周围白质软化、颅内感染、胆红素脑病及先天性畸形等疾病.使用振幅整合脑电图（amplitude integrated electroencephalography,aEEG）仪于生后3d内进行监测记录.比较2组新生儿脑电波形的连续性、睡眠-觉醒周期、爆发间期、最低和最高电压等指标的差异.采用x2检验、t检验和方差分析进行统计学处理. 结果 小于胎龄儿连续性脑电图的出现率、睡眠-觉醒周期出现率均低于适于胎龄儿[均为15.0％（9/60）与70.0％（28/40）,x2=31.14],爆发间期长于适于胎龄儿[（14.55±0.75）s与（5.09±0.89）s],最高和最低电压均低于适于胎龄儿[最高电压：（10.40±2.61）μV与（16.42±5.53）μμV;最低电压：（4.02±1.61）μμV与（6.98±3.82）μV],差异均有统计学意义（t值分别为57.21、6.43和4.63,P值均＜0.01）.出生体重位于同胎龄第5～10百分位、第3～百分位和低于第3百分位的小于胎龄儿之间,单纯低血糖组（血糖＜2.2 mmol/L、但未发生低血糖脑病）与正常血糖组之间以及单纯高胆红素血症组（血胆红素＞220 μ mol/L、但未发生胆红素脑病）与正常胆红素组患儿之间,连续性脑电图的出现率、睡眠-觉醒周期出现率、爆发间期以及最低和最高电压比较,差异均无统计学意义（P值均＞0.05）. 结论 胎儿生长受限可在一定程度上抑制脑功能发育.Objective To determine the adverse effects of fetal growth restriction （FGR） on the development of fetal cerebral function.Methods Sixty small for gestational age （SGA） and 40 appropriate gestational age （AGA） infants with a gestational age ranging from 37 weeks to 40＋6 weeks who were hospitalized in the Ba Yi Children＇s Hospital Affiliated to Beijing Military General Hospital were included in this study.Patients with fetal distress,birth asphyxia,hyperspasmia,intracranial hemorrhage,periventricular leukomalacia,intracranial infection,septicemia and congenital abnormalities were excluded from the study.Amplitude-integrated electroencephalography （aEEG） was used to monitor the baby＇s cerebral function within three days after birth.The monitoring time was two to four hours in each infant.The observational indices included continuity,sleep wake cycling （SWC）,interburst interval （IBI）,minimum voltage and maximum voltage.Student＇s t test,Chi-square test and analysis of variance were used to compare differences between the groups.Results Continuity：the frequency ofaEEG continuity in the SGA and AGA groups was 15.0％ （9/60） and 70.0％ （28/40）,respectively （x2=31.14,P=0.00）.SWC：the frequency of aEEG SWC in the SGA and AGA groups was 15.0％ （9/60） and 70.0％ （28/40） （x2=31.14,P-0.00）.IBI：the frequency of IBI in the SGAandAGAgroups was （14.55±0.75） s and （5.09±0.89） s （t=57.21,P=0.00）.Maximum voltage：the maximum voltage in the SGA and AGA groups was （10.40± 2.61） t V and （16.42± 5.53） μ V （t=-6.43,P=0.00）.Minimum voltage：the minimum voltage in the SGA and AGA groups was （4.02± 1.61） μ V and （6.98±3.82） μV （t=4.63,P=0.00）.Lower birth weight,hypoglycemia （without hypoglycemic encephalopathy） or hyperbilirubinemia （without bilirubin encephalopathy） had no significant influence on fetal cerebral function （all P＞0.05）.Conclusions SGA infants have poor continuity,absence of SWC,longer IBI,and lower max

关 键 词：胎儿生长迟缓 婴儿 小于胎龄 脑电描记术 

分 类 号：R742[医药卫生—神经病学与精神病学]