正常早产新生儿睡眠期排尿与大脑活动相关性研究

The relationship between bladder voiding and the brain activities during sleep in healthy preterm newborn children

目的应用视频脑电图探讨健康早产新生儿睡眠期排尿与大脑活动的相关性。方法选取28例正常单胎早产新生儿作为研究对象（男16例，女12例）。根据受孕龄（CA）分为3组（Ⅰ组≤31 ～33周11例，Ⅱ组≤33～35周7例，Ⅲ组≤35～37周10例）。每组均进行4 h（8：00～12：00）自由排尿观察，同步进行8导视频脑电图监测。记录排尿频率（VF）、每次排尿体积（VV）、B型超声测量排尿后残余尿量（PRV）及排尿时清醒/睡眠状态。结果共记录91次自由排尿，总体52.7%的排尿发生在清醒状态。间断排尿（10min内排尿次数≥2）13次，在总体排尿中占14.3%。Ⅲ组睡眠期排尿次数为2.4±1.0，显著少于其他两组（1.6±1.0、1.0±0.9，P＝0.00）。Ⅰ组PRV/BW为11.1±5.6，显著大于其他两组（7.6±2.5、6.6±4.2，P＝0.02）。各组组内睡眠状态下，排尿前5 s、排尿中及排尿后5 s脑电图参数比较：Ⅰ组、Ⅱ组脑电图电极Fp1-T3和Fp2-T4振幅差异有统计学意义，Ⅲ组脑电图电极C3-O1和C4-O2振幅差异有统计学意义（P〈0.05）。三组组间睡眠状态下，对排尿前5 s、排尿中及排尿后5s脑电图参数比较：脑电图电极Fp1-T3、C3-O1和T3-O1振幅差异有统计学意义（P〈0.05）。结论在早产新生儿，大脑已经参与控制排尿。随着年龄增长，早产新生儿大脑中心区域和枕区，尤其是左侧大脑皮层在排尿中发挥重要作用。

ObjectiveTo explore the relationship between voiding pattern and brain activities by using video-electroencephalogram （video-EEG） in healthy preterm newborn children.MethodsTwenty-eight healthy preterm neonates （16 boys and 12 girls） were recruited.Based on conceptual age （CA）, the subjects were divided into three groups ofⅠ （31 weeks ≤CA〈33 weeks; n=11）, Ⅱ （33 weeks ≤CA〈35 weeks; n=7） and Ⅲ （35 weeks≤CA〈37 weeks; n=10）. Video-EEG data from 8 cortical regions were recorded from 8 to 12 am.Meanwhile, voiding frequency （VF）, voiding volume （VV）, post-void residual volume （PRV） and status at voiding （awake/sleep） were recorded.ResultsA total of 91 voids were recorded. And 52.7% of all bladder voiding occurred during an awakened state.Intermittent voiding pattern （urination ≥2 every 10 min） was 13 times up to 14.3% of all voiding.VF in sleeping of group Ⅲ was significantly less than that of two other groups （2.4±1.0, 1.6±1.0, 1.0±0.9, P=0.00）. PRV/BW of groupⅠwas significantly larger than those of groups Ⅱ ＆ Ⅲ （11.1±5.6, 7.6±2.5, 6.6±4.2, P=0.02）. In each group, comparing EEG amplitude during quiet sleep voiding, 5 second before and after voiding, electrode pair Fp1-T3 and Fp2-T4 amplitude showed significant difference between groups Ⅰ＆ Ⅱ and electrode pair C3-O1 and C4-O2 amplitude showed significant difference in group Ⅲ （P〈0.05）. Comparing the amplitude among three groups during quiet sleep voiding, 5 second before and after voiding, electrode pair Fp1-T3, C3-O1 and T3-O1 showed significant differences （P〈0.05）. EEG frequency showed no statistical differences.ConclusionsDuring an early neonatal period, brain is involved in controlling bladder voiding.With advancing age, central brain and occipital area, especially left cerebral regions, play important roles in voiding control in preterm neonates.