不同低血糖持续时间对新生儿脑损伤的影响

Impact of Different Durations of Hypoglycemia on Neonatal Brain Injury

目的探讨不同低血糖持续时间对新生儿脑损伤的影响。方法对新生儿科2010年2月-2011年9月收治的86例由低血糖导致的脑损伤患儿进行回顾性研究。结果 (1)低血糖持续时间"24～h"在阵发性发绀、嗜睡、惊厥、呼吸暂停症状的人数多于"0～h"和"12～h","24～h"的无症状性低血糖人数多于其余两组;"24～h"的EEG和MRI的脑损伤检出率均高于其余两组,尤其在"阳性中央尖波(EEG)"和"单纯型两侧顶枕叶皮层高信号(MRI)"上。(2)低血糖持续时间与20项新生儿行为神经测定评分呈负相关(P<0.01);(3)ROC曲线提示低血糖持续时间取10.7 h作为截断点对于脑损伤的敏感度和特异度分别为72.6%和85.9%,曲线下面积是0.869(95%CI:0.723～0.937)。结论除了低血糖的最低值外,应提高低血糖持续时间对脑损伤的诊断价值,同时对于不同持续时间的侧重点不同,应及时的处理低血糖症状,防止新生儿的脑损伤。

Objective To explore the impact of different durations of hypoglycemia on neonaal brain injury. Methods A retrospective analysis was conducted on 86 neonates with brain damage caused by hypoglycemia. Results As for the symptoms of paroxysmal cyanosis, drowsiness, convulsions, and apnea, the number of neonates with 24- hours duration of hy- poglycemia was more than those with 0- hour and 12- hour durations of hypoglycemia, moreover, the number of asymptomatic neonates with 24- hours duration of hypoglycemia was more than those in the other two groups. The rates of brain injury de- tected by EEG and MRI in neonates with 24-- hours duration were both higher than those in the other two groups, especially on the item of ＂the positive central sharp waves＂ （EEG） and ＂simple type on both sides of the topoccipital cortex signal＂ （MRI）. There was a negative correlation between the duration of hypoglycemia and 20 neonatal behavioral neurological assessment scores （P^0.01）. ROC curve suggested that sensitivity and specificity of taking hypoglycemia duration lasting for 10.7 hours as the cutoff point for brain damage were 72.6% and 85.9%, and area under the curve was 0. 869 （95%CI： 0. 723 - 0. 937）. Conclusions In addition to the minimum value of hypoglycemia, the duration of hypoglycemia should be employed as an important index for the diagnosis of brain injury. According to different durations of hypoglycemia, targeted and detailed treatment should be given to the patients so as to prevent neonatal brain injury.