妊娠期高血压对新生儿脑损伤及脑发育影响的研究

Effect of hypertensive disorder complicating pregnancy on neonate brain damage and brain development

目的分析妊娠期高血压疾病孕妇分娩的新生儿颅脑超声图像特征,探讨妊娠期高血压疾病对新生儿脑损伤及脑发育的影响。方法对2013年10月至2014年8月哈尔滨医科大学附属第一医院新生儿重症监护室收治的妊娠期高血压疾病孕妇分娩的106例新生儿(研究组)和200例无高危围产因素孕妇分娩的新生儿(对照组)进行颅脑超声观察,比较两组新生儿颅脑超声异常表现,分析新生儿颅脑超声异常表现构成分布及颅脑超声异常表现与孕妇妊娠期高血压疾病程度的相关性。结果新生儿颅脑超声异常检出结果:(1)研究组106例,超声检出新生儿颅脑异常78例(73.6%,78/106),其中早产儿单发异常41例,包括脑室旁白质病损伤25例,脑室周围-脑室内出血14例,脑发育迟缓2例;合并异常15例;足月儿单发异常17例,包括脑室周围-脑室内出血12例,缺氧缺血性脑病3例,脑发育迟缓2例;合并异常5例。(2)对照组200例,超声检出新生儿颅脑异常73例(36.5%,73/200),其中早产儿单发异常30例,包括脑室旁白质损伤24例,脑室周围-脑室内出血4例,脑发育迟缓2例;合并异常15例;足月儿单发异常24例,包括脑室周围-脑室内出血10例,缺氧缺血性脑病14例;合并异常6例。(3)两组新生儿颅脑超声异常检出率比较差异有统计学意义(χ2=38.119,P<0.001),但两组新生儿颅脑超声异常构成分布比较差异无统计学意义(χ2=0.552,P=0.759)。(4)孕妇妊娠期高血压疾病程度与新生儿颅脑超声异常表现的相关性差异有统计学意义(P<0.001)。结论颅脑超声是新生儿脑异常首选和动态监测的方法,可为妊娠期高血压疾病孕妇分娩新生儿临床早期诊治及干预提供依据。

Objective To analyze the craniocerebrum ultrasonographic images of the infants born by women with hypertension in pregnancy and investigate the effect of hypertension in pregnancy on neonate brain injury and brain development. Methods To assess the brain injury and brain development, 106 infants born by women with hypertension in pregnancy（study group） and 200 infants born by women without high risk factors during perinatal period（control group） in the neonatal intensive care unit of First Affiliated Hospital of Harbin Medical University between 2013 and 2014 underwent brain ultrasonography. The abnormal ultrasound images and the constitution of abnormal ultrasound images distribution in two groups were compared. The relationship between the abnormal ultrasound images and the degree of hypertension in pregnancy were analyzed. Results The brain ultrasonographic result of the infants ：（1） In the group with hypertension in pregnancy, the abnormal ultrasound images were found in 78 cases（73.6%）. For the preterm infants, the solitary abnormality was found in 41 cases（25 cases of cerebral white matter injury, 14 cases of peri-intraventricular hemorrhage and 2 case of brain hypoevolutism） and multiple abnormalities were found in 15 cases; for the full-term infants, the solitary abnormality was found in 17 cases（12 cases of periintraventricular hemorrhage, 3 cases of hypoxic-ischemic encephalopathy and 2 case of brain hypoevolutism） and multiple abnormalities were found in 5 cases.（2） In the group without high risk factors, abnormalities were found in 73 cases（36.5 %）. For the preterm infants, abnormal ultrasound images were found in 45 cases, including solitary abnormality found in 30 cases（24 cases of cerebral white matter injury, 4 cases of peri-intraventricular hemorrhage and 2 case of brain hypoevolutism） and multiple abnormalities found in 15 cases; for the full-term infants, the abnormal ultrasound images were found in 30 cases, including solitary abnormality found in 24 cases（10 cases of peri-intraventricular hemorrhage and 14 cases of hypoxicischemic encephalopathy） and multiple abnormalities found in 6 cases.（3） There were obvious statistical significances between the comparativeness of two groups（χ2=38.119, P 0.001）, but there were no statistical significances in the constitution of the abnormal ultrasound images distribution between the two groups（χ2=0.552, P=0.759）.（4） There were statistical significances between the comparativeness of the abnormal ultrasound images and the degree of hypertensive disorder complicating pregnancy（P 0.001）. Conclusion Craniocerebrum ultrasonography is the first choice to detect and monitor brain abnormal and can provide basis for clinical diagnosis, treatment and intervention at early stage for the infants born by women with hypertension in pregnancy.