中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2013年
5期
278-283
,共6页
脑白质病%磁共振成像%认知障碍%精神运动性障碍%婴儿,早产
腦白質病%磁共振成像%認知障礙%精神運動性障礙%嬰兒,早產
뇌백질병%자공진성상%인지장애%정신운동성장애%영인,조산
Leukoencephalopathies%Magnetic resonance imaging%Cognition disorders%Psychomotor disorders%Infant,premature
目的 探讨早产儿生后早期头颅磁共振成像异常表现(脑白质损伤、脑室扩大及脑室出血)与其12月龄时智力及心理运动发育预后的关系. 方法 2007年3月15日至2011年4月12日,在解放军第二○二医院住院治疗的早产儿122例在出生8～14 d行头颅磁共振成像检查.患儿12月龄时成功随访其中的115例,采用智力发育指数和心理运动发育指数评估其神经发育预后,智力发育指数＜70分为智力发育障碍,～84分为边缘障碍,～114分为正常；心理运动发育指数＜70分为心理运动发育障碍,～84分为边缘障碍,～114分为正常.采用方差分析、LSD两两检验及Kruskal-Wallis H检验进行统计学分析. 结果 122例早产儿中男69例,女53例,中位胎龄32周(28～36周),中位出生体重2050 g(1270～3110 g).完成随访的115例早产儿中,智力发育障碍者24例,边缘障碍32例,另59例正常；心理运动发育障碍者20例,边缘障碍33例,另62例正常.24例智力发育障碍早产儿平均胎龄[(28.7±1.7)周]、出生体重[(1520.1±44.8)g]和1 min Apgar评分[(5.5±0.8)分]均显著小于智力发育正常的早产儿[n=59,(33.5±2.2)周、(2240.4±47.1)g和(7.1±o.8)分],而平均机械通气时间显著延长[(20.4±5.8)d与(5.6±2.7)d],差异均有统计学意义(t分别为2.37、2.49、2.13和2.44,P均＜0.05).20例心理运动发育障碍早产儿平均胎龄[(27.9±1.4)周]、出生体重[(1515.6±43.7)g]、1 min Apgar评分[(5.6±0.5)分]均显著小于心理运动发育正常的早产儿[n=62,(33.2±2.4)周、(2264.3±42.5)g和(7.2±0.6)分],而平均机械通气时间显著延长[(18.2±4.7)d与(5.3±2.2)d],差异均有统计学意义(t分别为2.28、2.52、2.09和2.38,P均＜0.05).13例脑白质重度损伤的患儿中11例发生智力发育障碍,9例发生心理运动发育障碍；11例中/重度脑室扩大的患儿中7例发生智力发育障碍,6例发生心理运动发育障碍.脑白质损伤程度和脑室扩大程度越重,智力发育障碍的发生率越高(H分别为16.23和14.33,P均＜0.05),心理运动发育障碍的发生率也越高(H分别为18.63和12.69,P均＜0.05). 结论 脑白质损伤在早产儿中较为常见,早产儿脑白质损伤及脑室扩大程度越重,其智力及心理运动发育预后越差.
目的 探討早產兒生後早期頭顱磁共振成像異常錶現(腦白質損傷、腦室擴大及腦室齣血)與其12月齡時智力及心理運動髮育預後的關繫. 方法 2007年3月15日至2011年4月12日,在解放軍第二○二醫院住院治療的早產兒122例在齣生8～14 d行頭顱磁共振成像檢查.患兒12月齡時成功隨訪其中的115例,採用智力髮育指數和心理運動髮育指數評估其神經髮育預後,智力髮育指數＜70分為智力髮育障礙,～84分為邊緣障礙,～114分為正常；心理運動髮育指數＜70分為心理運動髮育障礙,～84分為邊緣障礙,～114分為正常.採用方差分析、LSD兩兩檢驗及Kruskal-Wallis H檢驗進行統計學分析. 結果 122例早產兒中男69例,女53例,中位胎齡32週(28～36週),中位齣生體重2050 g(1270～3110 g).完成隨訪的115例早產兒中,智力髮育障礙者24例,邊緣障礙32例,另59例正常；心理運動髮育障礙者20例,邊緣障礙33例,另62例正常.24例智力髮育障礙早產兒平均胎齡[(28.7±1.7)週]、齣生體重[(1520.1±44.8)g]和1 min Apgar評分[(5.5±0.8)分]均顯著小于智力髮育正常的早產兒[n=59,(33.5±2.2)週、(2240.4±47.1)g和(7.1±o.8)分],而平均機械通氣時間顯著延長[(20.4±5.8)d與(5.6±2.7)d],差異均有統計學意義(t分彆為2.37、2.49、2.13和2.44,P均＜0.05).20例心理運動髮育障礙早產兒平均胎齡[(27.9±1.4)週]、齣生體重[(1515.6±43.7)g]、1 min Apgar評分[(5.6±0.5)分]均顯著小于心理運動髮育正常的早產兒[n=62,(33.2±2.4)週、(2264.3±42.5)g和(7.2±0.6)分],而平均機械通氣時間顯著延長[(18.2±4.7)d與(5.3±2.2)d],差異均有統計學意義(t分彆為2.28、2.52、2.09和2.38,P均＜0.05).13例腦白質重度損傷的患兒中11例髮生智力髮育障礙,9例髮生心理運動髮育障礙；11例中/重度腦室擴大的患兒中7例髮生智力髮育障礙,6例髮生心理運動髮育障礙.腦白質損傷程度和腦室擴大程度越重,智力髮育障礙的髮生率越高(H分彆為16.23和14.33,P均＜0.05),心理運動髮育障礙的髮生率也越高(H分彆為18.63和12.69,P均＜0.05). 結論 腦白質損傷在早產兒中較為常見,早產兒腦白質損傷及腦室擴大程度越重,其智力及心理運動髮育預後越差.
목적 탐토조산인생후조기두로자공진성상이상표현(뇌백질손상、뇌실확대급뇌실출혈)여기12월령시지력급심리운동발육예후적관계. 방법 2007년3월15일지2011년4월12일,재해방군제이○이의원주원치료적조산인122례재출생8～14 d행두로자공진성상검사.환인12월령시성공수방기중적115례,채용지력발육지수화심리운동발육지수평고기신경발육예후,지력발육지수＜70분위지력발육장애,～84분위변연장애,～114분위정상；심리운동발육지수＜70분위심리운동발육장애,～84분위변연장애,～114분위정상.채용방차분석、LSD량량검험급Kruskal-Wallis H검험진행통계학분석. 결과 122례조산인중남69례,녀53례,중위태령32주(28～36주),중위출생체중2050 g(1270～3110 g).완성수방적115례조산인중,지력발육장애자24례,변연장애32례,령59례정상；심리운동발육장애자20례,변연장애33례,령62례정상.24례지력발육장애조산인평균태령[(28.7±1.7)주]、출생체중[(1520.1±44.8)g]화1 min Apgar평분[(5.5±0.8)분]균현저소우지력발육정상적조산인[n=59,(33.5±2.2)주、(2240.4±47.1)g화(7.1±o.8)분],이평균궤계통기시간현저연장[(20.4±5.8)d여(5.6±2.7)d],차이균유통계학의의(t분별위2.37、2.49、2.13화2.44,P균＜0.05).20례심리운동발육장애조산인평균태령[(27.9±1.4)주]、출생체중[(1515.6±43.7)g]、1 min Apgar평분[(5.6±0.5)분]균현저소우심리운동발육정상적조산인[n=62,(33.2±2.4)주、(2264.3±42.5)g화(7.2±0.6)분],이평균궤계통기시간현저연장[(18.2±4.7)d여(5.3±2.2)d],차이균유통계학의의(t분별위2.28、2.52、2.09화2.38,P균＜0.05).13례뇌백질중도손상적환인중11례발생지력발육장애,9례발생심리운동발육장애；11례중/중도뇌실확대적환인중7례발생지력발육장애,6례발생심리운동발육장애.뇌백질손상정도화뇌실확대정도월중,지력발육장애적발생솔월고(H분별위16.23화14.33,P균＜0.05),심리운동발육장애적발생솔야월고(H분별위18.63화12.69,P균＜0.05). 결론 뇌백질손상재조산인중교위상견,조산인뇌백질손상급뇌실확대정도월중,기지력급심리운동발육예후월차.
Objective To investigate the relationship between early brain menifestation such as white matter damage and ventriculomegaly detected by magnetic resonance imaging(MRI) and adverse neurodevelopmental outcome in preterm infants.Methods From March 15,2007 to April 12,2011,122 preterm infants accepted MRI examination 8-14 days after birth in Chinese People's Liberation Army 202 Hospital.Totally,115 preterm infants were followed up at 12 months old and mental development index(MDI) and psychomotor development index (PDI) score were measured.MDI＜70 was as mental dysfunction,-84 as borderline dysfunction and-114 as normal; PDI＜70 was as psychomotor dysfunction,-84 as borderline dysfunction and-114 as normal.The relationship between clinical characteristics of preterm infants,MRI abnormalities and neurodevelopmental outcome were analyzed by analysis of variance,LSD and Kruskal-Wallis H test.Results The 122 premature infants included 69 males and 53 females with the median gestational age of 32 weeks(28-36 weeks)and the median birth weight of 2050 g (1270-3110 g).In 24 premature infants with mentaldysfunction,the average gestational age [(28.7 ± 1.7) weeks],birth weight[(1520.1-44.8) g] and 1 min Apgar score (5.5 ± 0.8) were all lower than those in normal infants [n =59,(33.5 ± 2.2)weeks,(2240.4 ± 47.1) g and 7.1 ± 0.8],while the average mechanical ventilation time was longer [(20.4±5.8) dvs (5.6±2.7) d](t=2.37,2.49,2.13 and 2.44,P＜0.05).In 20 premature infants with psychomotor dysfunction,the average gestational age [(27.9 ±± 1.4) weeks],birth weight [(1515.6±43.7) g],1 min Apgar score (5.6t0.5) were lower than those in normal infants [n=62,(33.2±2.4) weeks,(2264.3±42.5) g and 7.2±0.6],while the mechanical ventilation time was longer [(18.2±4.7) dvs (5.3±2.2) d](t=2.28,2.52,2.09 and 2.38,P＜0.05).Among thirteen preterm infants with severe white matter damage,eleven and nine developed mental or psychomotor dysfunction respectively.Among eleven preterm infants with moderate and severe ventriculomegaly,seven and six developed mental or psychomotor dysfunction respectively.The more severe the white matter damage and ventriculomegaly,the higher the incidence of mental (H=16.23 and 14.33,P＜0.05) and psychomotor dysfuction (H =18.63 and 12.69,P ＜ 0.05).Conclusions White matter damage is common in preterm infants.Prognosis of preterm infants with mental and psychomotor dysfunction is related with the degree of white matter damage and ventriculomegaly.
