产前应用地塞米松对早产儿血糖及胆红素水平的影响

Effect of prenatal dexamethasone on the level of blood glucose and bilirubin in premature infants

目的观察产前应用地塞米松对早产儿空腹血糖及胆红素水平的影响。方法选择济宁医学院附属医院新生儿重症监护病房收治的30~34周的早产儿,共80例,根据早产儿母亲产前是否肌肉注射地塞米松分为观察组和对照组,其中观察组40例,对照组40例。观察组早产儿母亲产前肌肉注射地塞米松,对照组早产儿母亲均胎膜早破3 h内分娩,未予肌注地塞米松治疗;另外选取40例足月新生儿为足月儿组。测定各组血清胆红素及空腹血糖水平的变化。结果出生24 h后,观察组7例出现低血糖症,对照组4例出现低血糖症,两组比较差异无统计学意义(χ~2=0.95,P>0.05)。出生3 d后,观察组8例出现高胆红素血症,对照组4例出现高胆红素血症,两组比较差异无统计学意义(χ~2=1.57,P>0.05)。观察组30~32周出生24 h、2 d、3 d后胆红素水平[分别为(58.82±8.55)μmol/L,(136.12±23.09)μmol/L,(215.29±25.99)μmol/L]与33~34周组比较水平[分别为(58.88±6.50)μmol/L,(128.76±25.99)μmol/L,(204.86±28.04)μmol/L],差异无统计学意义(t=0.32,0.93,1.20;P>0.05)。观察组30~32周出生24 h后血糖水平[(2.50±0.60)mmol/L]与33~34周组比较[(2.63±0.51)mmol/L],差异无统计学意义(t=0.73,P>0.05)。观察组早产儿出生24 h、2 d及3 d后胆红素水平[分别为(58.82±7.35)μmol/L,(131.84±24.80)μmol/L,(209.30±27.36)μmol/L]均高于对照组[分别为(51.64±6.33)μmol/L,(114.91±20.35)μmol/L,(157.15±37.62)μmol/L]及足月新生儿组[分别为(52.16±8.21)μmol/L,(120.38±14.71)μmol/L,(166.38±30.10)μmol/L],3组比较差异有统计学意义(F=11.96,5.99,30.26;P<0.01)。观察组早产儿出生24 h后血糖水平[(2.58±0.55)mmol/L]低于对照组[(2.91±0.52)mmol/L]及足月新生儿组[(3.03±0.61)mmol/L],3组血糖水平比较差异有统计学意义(F=6.84,P<0.01)。观察组、对照组及足月儿组出生2 d后血糖水平比较,分别为(3.95±1.05)mmol/L,(4.06±0.95)mmol/L,(4.14±0.83)mmol/L,差异无统计学意义(F=0.39,P>0.05)。观察组、对照组及足月儿组出生3 d后血糖水平分别为[(4.09±0.90)mmol/L,(4.12±0.98)mmol/L,(4.24±1.00)mmol/L]比较,差异无统计学意义(F=0.262,P>0.05)。观察组30~32周出生24 h,2 d,3 d后胆红素水平[分别为(58.82±8.55)μmol/L,(136.12±23.09)μmol/L,(215.29±25.99)μmol/L]与33~34周组比较[分别为(58.88±6.50)μmol/L,(128.76±25.99)μmol/L,(204.86±28.04)μmol/L],差异无统计学意义(t=0.32,0.93,1.20;P>0.05)。观察组30~32周出生24 h后血糖水平[(2.50±0.60)mmol/L]与33~34周组比较[(2.63±0.51)mmol/L],差异无统计学意义(t=0.73,P>0.05)。结论产前应用地塞米松可能降低早产儿血糖水平,升高血清胆红素水平。

Objective To investigate the effect of prenatal dexamethasone on the level of bloodglucose and bilirubin in premature infants.Methods Eighty preterm infants deliveried between 30 and 34weeks were enrolled in our neonatal intensive care unit.Infants whose mothers received dexamethasone beforedelivery （ observation group： n = 40） were compared with those infants whose mothers did not receivedexamethasone （ control group： n = 40）. Forty cases of full-term newborn were selected as term newborngroup.The changes of serum bilirubin and blood glucose levels were determined.Results There were 7 casesof premature infants with hypoglycemia in the observation group,and there were 4 cases of premature infantswith hypoglycemia in the control group 24 hours after birth.There was no significant difference between thetwo groups （ χ2= 0.95, P 〉0.05）.There were 8 cases of premature infants with hyperbilirubinemia in theobservation group,and there were 4 cases of premature infants with hyperbilirubinemia in the control group 3days after birth,and there was no significant difference between the two groups （ χ2= 1. 57, P 〉 0. 05）.Bilirubin levels in 24 hours,2 days and 3 days after birth were higher in the observation group [（ 58.82±7.35）μmol / L,（131.84±24.80）μmol / L,（209.30±27.36）μmol / L respectively] than those in control group[（51.64± 6. 33） μmol / L, （ 114. 91 ± 20. 35） μmol / L, （ 157. 15 ± 37. 62） μmol / L, respectively] and termnewborn group [（52.16±8.21）μmol / L,（120.38±14.71）μmol / L,（166.38±30.10）μmol / L respectively],bilirubin levels showed significant difference among the three groups （ P 〈0.01）.Blood glucose levels werelower in the observation group [（2.58±0.55）mmol / L]than that in control group [（2.91±0.52）mmol / L]andterm newborn group [（3.03±0.61）mmol / L] in 24 hours after birth,blood glucose levels showed significantdifference among the three groups （ P 〈 0. 01）. There was no significant difference in blood glucose levelamong observation group,control group and term newborn group 2 days after birth[（3.95±1.05）mmol / L,（4.06±0.95） mmol / L, （ 4. 14 ± 0. 83） mmol / L respectively]. There was no significant difference in bloodglucose level among observation group,control group and term newborn group 3 days after birth [（ 4. 09 ±0.90）mmol / L,（4.12±0.98）mmol / L,（4.24±1.00）mmol / L respectively].There was no significant difference in bilirubin between gestational age 30 ～ 32 weeks in 24 hours, 2 days and 3 days after birth in theobservation group[（58.82±8.55）μmol / L,（136.12±23.09）μmol / L,（215.29±25.99）μmol / L respectively]and 33～ 34 weeks of gestational age group[（ 58.88± 6.50） μmol / L,（ 128.76± 25.99） μmol / L,（ 204.86±28.04）μmol / L respectively]. There was no significant difference in blood glucose between gestational age30～ 32 weeks[（2.50±0.60）mmol / L]and 33～ 34 weeks of gestational age group[（2.63±0.51）mmol / L] inthe observation group in 24 hours after birth.Conclusion Prenatal dexamethasone might decrease the bloodglucose level and increase the level of serum bilirubin in preterm infants.