缺氧缺血性脑病患儿智力发育状况与血糖异常的关联

Intellectual development and abnormal blood sugar in newborns with hypoxic ischemic encephalopathy

目的:探讨患有可引起脑发育迟缓、脑瘫、智力低下、癫痫等后遗症的缺氧缺血性脑病小儿智力发育状况与血糖的关系。方法:选择1999-01/2002-12在辽宁省人民医院住院治疗的符合纳入标准的新生儿缺血缺氧性脑病患儿56例,男30例,女26例。①患儿入院时及入院后每隔4h检测1次血糖,据此调整葡萄糖用量至血糖正常;同时做头颅CT及脑电图检查。②采用中国儿童发展中心婴幼儿智能发育检查量表评估3和6月龄婴幼儿智力发育程度(以智力发育指数表示,根据规定项目测试中的得分,在标准化量表中查得,<50为有智力障碍,组间比较,指数较大的智力发育状况较佳)。③采用盖泽尔发育诊断量表(动作能、应物能、应人能、言语能。根据小儿在规定项目测试中的得分和实际年龄可推算出发育商。发育商=测得的成熟年龄/小儿实际年龄×100%。总分为动作能、应物能、应人能、言语能的发育商平均值,总分<85,则表明机体可能存在某种损伤,可能有严重的落后;组间比较,总分较大的智力发育状况较佳)评估12～24月龄小儿智能发育情况,并了解后遗症发生情况。结果:纳入新生儿缺氧缺血性脑病患儿56例,进入结果分析41例,病情危重死亡7例,家长要求自动退院8例。①婴幼儿智力发育指数:血糖正常组3和6月龄婴幼儿高于血糖异常组(94.89±8.73,95.63±10.75;86.58±13.95,87.68±12.69,t=2.203,2.083,P<0.05)。②盖泽尔发育诊断量表总分:血糖正常组明显高于血糖异常组(102.84±8.66,95.42±7.24,t=2.866,P<0.01)。③发生后遗症例数:血糖异常组高于血糖正常组犤7例(35%),2例(10%),χ2=3.881,P<0.05犦。④头颅CT和脑电图检查结果:血糖正常组24例,其中头颅CT显示合并颅内出血6例(25%),脑电图异常5例(21%);血糖异常组32例,其中头颅CT显示合并颅内出血21例(66%),脑电图异常20例(62%)。结论:血糖异常小儿较血糖正常更易发生智力障碍和后遗症及脑CT和脑电图的异常,因此维持缺氧缺血性脑病患儿血糖在正常水平,可能有利于减少其脑功能损伤和改善婴幼儿智能发育。

AIM： To study the association between intellectual development and blood 6ugar in newborns with hypoxic ischemic encephalopathy （HIE）, which can cause brain hypoevolutism, cerebral palsy, mental retardation, epilepsy and other sequelae. METHODS： Fifty-six HIE newborns meeting the inclusive criteria were enrolled from the impatients of Liaoning People＇s Hospital from January 1999 to December 2002, including 30 males and 26 females. ①After admission, all the HIE newborns had an examination in blood sugar every 4 hours to regulate blood sugar level until it recovered to normal. Meanwhile, CT and electroencephalograph （EEG） examinations were conducted. ② Infant intellectual development measure scale designed by China Children Development Center was used to assess the intellectual development level of infant at 3 and 6 months of age. Intellectual development level was expressed by development index. Infant with a score 〈 50 was considered as having dysnoesia. The bigger the index was, the better the intellectual development was. ③ Gesell development scale was used to assess the intellectual development of infants at 12-24 months of age, and then to study the occurrence of sequelae. Gesell development scale measures four areas： motricity, adaptation, speech and sociability. Developmental quotient can be calculated according to the score on scale and actual age. Developmental quotient= Mature age/actual age × 100%. Total score is the average score on motricity, adaptation, speech and sociability. If total score was less than 85, it was indicated that some body injuries exist, maybe dropping behind seriously. A higher score indicated a better intellectual development. RESULTS： Fifty-six newborns were enrolled in the study, but only 41 ones were involved in the result analysis. Other 15 included 7 cases of death and 8 cases discharged according to the demand of their parents. ① Among infants at 3 and 6 months of age, intellectual developmental index was higher in infants with normal blood sugar than those with abnormal blood sugar （94.89±8.73,95.63±10.75;86.58±13.95,87.68±12.69,t=2.203, 2.083, P 〈 0.05）. ② Total score on Gesell development scale was higher in nornal blood sugar group than in abnormal blood sugar group （102.84±8.66, 95.42 ±7.24,t =2.866, P 〈 0.01 ）. ③ Cases of sequelae were more in abnormal blood sugar group than in normal blood sugar group [7 cases （35%）,2 cases（10%）,X^2=3.881, P 〈 0.05]. ④ Brain CT and EEG： Of the 24 cases of normal blood sugar, there were 6 cases （25%） of intracranial hemorrhage showed by CT, and 5 cases （21%） of abnormal EEG; Of the 32 eases of abnormal blood sugar, there were 21 cases （66%）of intracranial hemorrhage showed by CT, and 20 cases（62%） of abnormal EEG. CONCLUSION： Infants with abnormal blood sugar are more likely to have dysnoesia, sequelae, and abnormal CT and EEG than those with normal blood sugar. Therefore, it is beneficial to decrease brain functional injury and improve intellectual development through maintaining blood sugar at a normal level in HIE infants.