早产儿早期脑反应性与神经发育关系的研究

Relationship between early brain responses and neurodevelopment in preterm infants

摘要:

目的 研究早产儿早期脑对外界刺激的反应性与神经发育的关系 ,早期对早产儿进行脑功能的评价 ,为了解其神经发育水平、估价预后提供客观证据。方法 应用近红外光谱测定技术 ,对不同胎龄的早产儿进行脑氧合状态的监测 ,观察声刺激后脑反应性的变化 ;在纠正胎龄 4 0周时行新生儿神经行为评分 (NBNA) ,并进行神经发育随访 ,评价早产儿早期脑反应性与其后神经发育的关系。结果 本组早产儿生后对声刺激均显示出不同程度的反应 ,34周后的早产儿声刺激后最大反应值为 4 .1%± 1.4 % ,2 0例足月儿声刺激后最大反应值为 4 .2 %±1.4 % ,两者差异无显著性 ;小于 34w的早产儿声刺激后最大反应值为 3.1%± 1.4 % ,与足月儿相比差异有显著性(P <0 .0 5 )。有脑损伤早产儿声刺激后最大反应值为 2 .6 %± 1.8% ,无脑损伤早产儿声刺激后最大反应值为4 .4 %± 1.3% ,两者相比有统计学差异 (P <0 .0 5 )。纠正胎龄 4 0周的NBNA异常儿与正常儿比较 ,早期脑反应性有显著性差异 (P <0 .0 5 )。婴幼儿期随访 ,神经发育异常与正常儿比较 ,早期脑反应性也有显著性差异 (P <0 .0 5 )。结论 早产儿具备对声刺激后的脑反应性 ,成熟度越低 ,脑反应性越差。围产期脑损伤可影响脑的反应性。早期的脑反应性与神经发育水平有关。

Abstract:

Objective This paper aims to study the effects of the brain development and brain injury on early brain responses and to explore the relationship between early brain responses and neurodevelopment in preterm infants. Methods The intensity of brain responses after sound stimulation was evaluated by detecting cerebral oxygenation using near infrared spectroscopy (NIRS) in preterm infants. The neonatal behavioral neurological assessment (NBNA) was performed in preterm infants on the 40th week of their corrected gestational age (GA). The infants had follow-up visits for the neurodevelopment within one year of their lives. Results All subjects had responses to sound stimulation in different degrees. The maximum response value after stimulation in infants with GA of more than 34 weeks' was 4.1%±1.4%. It was not different from that of term infants ( 4.2%± 1.4%). There was a significant difference in maximum response value between the infants with GA of less than 34 weeks and the term infants ( 3.1%± 1.4% vs 4.2%± 1.4%; P< 0.05). The maximum response value of the preterm infants with brain injury ( 2.6%± 1.8%) was lower than those without ( 4.4%± 1.3%) (P< 0.05). The preterm infants who had normal NBNA results had higher maximum response values than those who did not have on the 40th week of their corrected GA ( 3.9%± 1.4% vs 2.1%±1.6%; P< 0.05). The follow-up visits found a significant difference between the normal and abnormal neurodevelopment infants for the early brain response (P< 0.05). Conclusions Preterm infants have brain responses to sound stimulation. The intensity of brain response may be correlated with GA. The perinatal brain injury may affect the brain response. Early response may be related to subsequent neurodevelopment in preterm infants.