宫内感染新生儿血糖代谢异常97例分析

Clinical observations of abnormalities of glucose metabolism in 97 neonates with intrauterine infection

对97例确诊为宫内感染新生儿 ,观察其血糖异常发生率及感染程度对血糖代谢的影响。其中TORCH感染IgM抗体阳性48例 ,细菌感染49例。对照组为同期出生的正常新生儿81例。观察对象在生后24小时和72小时各采血1次 (距哺乳时间4～6小时 ) ,感染组随着病情进展及时监测血糖及电解质 ,葡萄糖输注浓度为7.5 % ,补糖量为6～7.5mg/(kg·h)。结果 :①低血糖和高血糖发生率在不同成熟度感染儿的差异不明显 (χ2=1.79,P>0.05;χ2=0.53,P>0.05) ;但感染组明显高于对照组 (χ2=8.85,P<0.01;χ2=11.71,P<0.01)。②重度感染组高血糖发生率和血糖升高值显著高于轻中度感染组 (χ2=29.43,P<0.01 ;t'=25.2,P<0.01) ;而低血糖发生率两组差异不显著 ,但血糖降低值重度感染组显著低于轻中度组 ,差异明显 (χ2=0.02,P>0.05;t=6.75,P<0.001)。③重度感染组的死亡病例 ,血糖升高值显著高于存活病例 (t=17.6,P<0.001)。④低血糖病儿临床表现以呼吸、循环系统异常多见 ,高血糖病儿以神经系统异常为主。提示胎儿宫内感染 ,出生后感染扩散 ,引起强烈的应激反应 ,以致内分泌调节血糖功能发生紊乱 ;感染愈重机体内环境紊乱愈重 ,最终导致内分泌调节血糖功能处于衰竭状态。因而对感染的新生儿监测血糖对预防高渗血症引起的脑损伤和判断预?

To observe the abnormalities of blood glucose in neonates with intrauterine infection and the effects of infection on glucose metabolism,97 neonates with confirmed diagnosis of intrauterine infection were included to this study.Among them,48 cases were positive with IgM antibody to TORCH infections;49 cases were bacterial infections.81 normal neonates were used as controls.Two blood samples were collected at 24 hours and 72 hours after birth from each patient and control subject.Blood glucose and electrolytes were measured for each sample.The results showed that there was no significant difference in the incidence of hypoglycemia and hyperglycemia among infected newborns between mature and immature newborns(P>0.05).In severe infection newborns,the blood glucose levels were significantly higher than those in mild infection newborns(P<0.01),especially in dead newborns.Respiratory and circulatory systems dysfunction was the mainly clinical manifestation in newborns with hypoglycemia,whereas the neurological disorders are main symptoms of hyperglycemia newborns.Therefore,it is concluded that intrauterine infection can cause severe neurological and endocrinologic malfunction of newborns,especially in glucose metabolism regulation.It is important to monitor the blood glucose level in intrauterine infected newborns.