糖尿病母亲婴儿吞咽困难的临床研究  

The Clinical Study of Swallowing Difficulties in Infants of Diabetic Mothers

作　　者：苗旭丹 刘定 赵聪 刘亚兰 查慧 Miao Xudan;Liu Ding;Zhao Cong(Department of Pediatrics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院儿科,武汉430022

出　　处：《华中科技大学学报（医学版）》2024年第2期229-232,245,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省卫生健康委员会资助项目(No.WJ2023M027)。

摘　　要：目的探讨母亲糖尿病对足月儿吞咽困难的影响。方法采用前瞻性队列研究方法,收集2020年1月至2023年6月华中科技大学同济医学院附属协和医院新生儿重症监护病房的足月新生儿病例资料,包括一般资料和围生期资料。对出现吞咽困难的足月儿进行吞咽呼吸暂停和新生儿口腔运动评估量表(NOMAS)评估,并收集心脏超声、头颅磁共振、振幅整合脑电图(aEEG)及新生儿行为神经测定(NBNA)等检查结果。依据母亲是否合并糖尿病分为糖尿病母亲婴儿组(IDM组)和非糖尿病母亲婴儿组(非IDM组),比较两组足月儿吞咽困难的发生情况,并进行危险因素分析。结果共纳入足月儿1972例,其中IDM组593例,非IDM组1379例。与非IDM组相比,IDM组胎龄较小[(38.25±0.96)周vs.(38.54±1.01)周],剖宫产率(73.02%vs.57.51%)和大于胎龄儿发生率(13.99%vs.6.45%)较高(均P<0.05)。IDM组吞咽困难发生率明显高于非IDM组(3.37%vs.0.87%,P<0.05)。自发性吞咽时,IDM组吞咽困难患儿出现吞咽呼吸暂停的比例高于非IDM组(45.00%vs.8.33%,P<0.05);而咽部诱导适应性吞咽时,两组患儿出现吞咽呼吸暂停的比例差异无统计学意义(20.00%vs.8.33%,P>0.05)。吞咽困难患儿NOMAS评分中,IDM组口腔运动紊乱评分和口腔运动障碍评分均较非IDM组增高(均P<0.05),口腔运动正常得分两组无显著差异(P>0.05)。单因素分析发现,IDM发生吞咽困难(RR=3.87,95%CI:1.87~7.96)、剖宫产(RR=1.29,95%CI:1.05~1.59)及大于胎龄儿(RR=2.16,95%CI:1.56~2.97)风险增加(均P<0.05)。此外,71.88%的吞咽困难患儿存在aEEG异常,81.25%的吞咽困难患儿存在NBNA评分异常,其中IDM组吞咽困难患儿的aEEG异常发生率及NBNA异常发生率均高于非IDM组(85.00%vs.50.00%,90.00%vs.58.33%,均P<0.05)。结论母亲糖尿病是新生儿吞咽困难的危险因素,吞咽困难可能是IDM脑损伤的早期表现。Objective To determine the risk of swallowing difficulties in full-term infants of diabetic mothers(IDM).Methods This prospective cohort study analyzed perinatal data from full-term neonates in neonatal intensive care unit(NICU)of union Hospital,Tongji Medical College,Huazhong University of Science and Technology between January 2020 and June 2023.Full-term infants with swallowing difficulties were evaluated by frequency of deglutition apneas and Neonatal Oral Motor Assessment Scale(NOMAS).Then their data of echocardiography,brain magnetic resonance imaging(MRI),amplitude-integrated electroencephalography(aEEG)and neonatal behavioral neurological assessment(NBNA)were collected.According maternal diabetes condition,the infants were divided into IDM group and non-IDM group.The incidence of swallowing difficulties was compared between the two groups.Univariate analysis was performed on swallowing difficulties in IDM.Results A total of 1972 full-term infants were enrolled in this study,including 593 infants in IDM group and 1379 infants in non-IDM group.Compared with the non-IDM group,the gestational age in IDM group was smaller,and the incidence of cesarean section(73.00%vs.56.70%)and large for gestational age(13.90%vs.6.45%)were higher(all P<0.05).The incidence of swallowing difficulties was higher in IDM group(3.37%vs.0.87%,P<0.05).During spontaneous swallowing,proportion of deglutition apneas was higher in IDM group(45.00%vs.8.33%,P<0.05),whereas during adaptive swallowing,proportions of deglutition apnea were similar in IDM group and non-IDM group(20.00%vs.8.33%,P>0.05).For the NOMAS of the infants of swallowing difficulties,the score of disorganized sucking pattern and the score of dysfunctional sucking pattern in IDM group were higher than those in non-IDM group(both P<0.05).There was no difference between the two groups in normal oral motion scores(P>0.05).Univariate analyses showed that swallowing difficulties(RR=3.87,95%CI:1.87-7.96),cesarean section(RR=1.29,95%CI:1.05-1.59)and large for gestational age(RR=

关 键 词：糖尿病母亲婴儿 吞咽困难 新生儿口腔运动评估 脑损伤 

分 类 号：R722.19[医药卫生—儿科]