新生儿缺氧缺血性脑病高血糖及其临床意义

Hyperglycemia and its Clinical Significance in Newborn Infants with Hypoxic Ischemic Encephalopathy

目的 探讨新生儿缺氧缺血性脑病（ＨＩＥ）应激性高血糖的发生情况及其临床意义。 方法 采用美国强生公司生产的ＯＮＥＴＯＵＣＨ Ⅱ血糖仪及配套试纸对６０例ＨＩＥ患儿进行血糖监测。标本来自桡动脉血做完血气后所剩血液。 结果 发现入院时治疗前高血糖１９／６０例（３２％ ），其中轻度无一例高血糖，中度３／２３（１３％ ）重度１６／１８（８９％ ），中、重度相比差异有非常显著性（Ｐ＜ ０．０１）。重度ＨＩＥ患儿治疗前血糖明显高于轻、中度差异有非常显著性（Ｐ均＜ ０．０１）；ｐＨ值和ＢＥ值均明显低于轻、中度（前者Ｐ均＜ ０．０５，后者Ｐ均＜ ０．０１）。且１９例高血糖ＨＩＥ患儿治疗前的血糖值与ｐＨ值、ＢＥ负值均呈显著负相关（前者Ｐ＜ ０．０５，后者Ｐ＜ ０．０１）。治疗前血糖越高，病死率越高。 结论 ＨＩＥ患儿病情越重，应激反应越强烈，血糖升高越明显，脑细胞酸中毒越重，预后越差。因此。

Objective To study the incidence and the clinical significance of stressing hyperglycemia in newborn infants with hypoxic ischemic encephalopathy (HIE). Methods The pretreated blood glucose (BG) of 60 cases with HIE was tested with One Touch Ⅱ glucose meter before treatment. Results 19 of the 60 cases (32%) had hyperglycemia,3 of them with moderate HIE and 16 with severe HIE, while no hyperglycemia was found in the mild ones. The incidence of hyperglycemia between the moderate cases and the severe cases was significant statistically ( P<0.01 ).The pretreated BG in the severe cases was obviously higher( P< 0.01 ), and the pH value ( P<0.05 ) and BE negative value( P<0.01 ) were much lower than those in the mild and the moderate cases. The pretreated. BG had significantly negative relation with the pH value ( P<0.05 ) and BE ( P< 0.01 ) in the 19 cases of hyperglycemia. The higher pretreaed BG, the higher the mortality. The mortality was 60% and 100% respectively when BG was 15～20 mmol/L and more than 20 mmol/L. Conclusion The more severe the HIE is, the stronger stress will be; the higher BG, and more severe acidosis are the indicators of the poor prognosis . BG test before treatment is a secondary marker to evaluate the situation and prognosis of neonates with HIE.