新生儿低血糖脑损伤临床特征与脑电图监测

Clinical features and EEG monitoring of neonatal hypoglycemic brain injury

目的探讨新生儿低血糖脑损伤(HBD)时的脑电图(EEG)改变与临床预后关系,为HBD的诊断及预防提供依据。方法监测住院新生儿血糖并描记入院后24～72 h的EEG,低血糖新生儿于入院后2周再次EEG检查。分析比较低血糖新生儿与正常血糖新生儿,以及无症状性与症状性低血糖患儿EEG的异常率以及预后。结果入组100例新生儿,其中低血糖组52例,正常血糖组48例;低血糖组新生儿中症状性低血糖25例,无症状性低血糖27例。EEG异常率低血糖组新生儿73.1%(38/52),正常血糖组12.5%(6/48),两者差异有统计学意义(χ2=37.17,P<0.05)。低血糖组新生儿中,症状性低血糖组EEG异常率96%(24/25),无症状性低血糖组51.9%(14/27),两者差异有统计学意义(χ2=10.7,P<0.05)。新生儿血糖越低、持续时间越长,则EEG异常越严重。EEG中重度异常新生儿,大多遗留认知障碍、癫疒间、脑瘫等后遗症。结论新生儿HBD与低血糖的严重程度及持续时间密切相关。EEG能客观、直接地反映脑细胞的功能状态及损害程度,有助于早期评估脑损伤的程度及预后。

Objective To investigate the relationship between abnormal electroencephalogram（EEG）results and clinical prognosis in hypoglycemic brain damage（HBD）in neonates,and to provide evidence for HBD diagnosis and prevention.Methods A total of 100 neonates admitted to the hospital were studied and divided into two groups：hypoglycemic group（n = 52）and normal controls（n = 48）.Neonates in hypoglycemic group were divided into two subgroups：symptomatic hypoglycemic group（group A,n = 25）and asymptomatic hypoglycemic group（group B,n = 27）.Blood glucose was monitored in all neonates immediately after admission and EEG examination was performed 24-72 hours after admission.Repeated EEG examination was performed in hypoglycemic group 2 weeks after admission.Results Hypoglycemic brain damage was commonly associated with seizure,lethargy and decreased muscle tone.Coma and respiratory failure could be observed in some severe cases.HBD could also cause irreversible brain damage and some degree of sequelae including cognitive disorder,epilepsy and cerebral palsy.Abnormal EEG incidence was significantly higher in hypoglycemic group（73.1%,38/52）than in control group（12.5%,6/48）（χ2 = 37.17,P 0.005）.Abnormal EEG incidence was significantly higher in symptomatic hypoglycemic group（96%,24/25） than in asymptomatic hypoglycemic group（51.9%,14/27）（χ2 = 10.7,P 0.005）.Conclusions Neonatal HBD is closely associated with the severity and duration of hypoglycemia.EEG can objectively and directly reflect the function and lesion extent of damaged brain cells and provide a tool for early evaluating the degree and prognosis of brain damage.