Neonates,Asphyxia| Magnetic resonance imaging| Neurodevelopment| Prognosis,"/> 窒息新生儿磁共振成像与神经系统预后的相关研究
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发育医学电子杂志  2018, Vol. 6 Issue (4): 225-230    DOI: 10.3969/j.issn.2095-5340.2018.04.007
  围产医学   论著 |新生儿 |
窒息新生儿磁共振成像与神经系统预后的相关研究
华国伟 于敏 江凯华 郑爱斌 李红新
1. 南通大学附属常州儿童医院新生儿科/ 健康研究中心,江苏 常州 213003 ;2. 南通大学 医学院,江苏 南
通 226001
Research of magnetic resonance imaging and neurological prognosis in asphyxiated neonates
HUA Guo-wei,YU Min, JIANG Kai-hua, ZHENG Ai-bin, LI Hong-xin
1 (1.Department of Neonatology,the Affiliated Changzhou Children’s Hospital of Nantong University, Jiangsu, Changzhou 213003, China;2.Medical School of Nantong University, Jiangsu, Nantong 226001, China)
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摘要 【摘要】 目的  探讨窒息新生儿MRI 检查结果及其相关临床资料与神经系统预后的相关性。 方法2013 年1 月至2015 年12 月,在南通大学附属常州市儿童医院新生儿科住院的足月窒息新生儿中,纳入资料完整的46 例患儿为研究对象。日龄6 ~ 14 天时进行MRI 检查。采集临床资料。12 月龄时根据婴幼儿智能测验量表(children's developmental center of China,CDCC),计算智力发育指数(mentaldevelopment index,MDI)和运动发育指数(psychomotive development index,PDI)。采用t 检验、χ2 检验或Fisher 确切概率法进行统计分析。 结果  重度窒息组与轻度窒息组患儿CDCC 评分异常的比例[66.7%(16/24)与22.7%(5/22)]、MRI 异常的比例[79.2%(19/24)与36.4%(8/22)]、基底节/ 丘脑区异常的比例[45.8%(11/24)与9.1%(2/22)]、缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)发生率[91.7%(22/24)与22.7%(5/22)]比较,重度窒息组较高(P 值均﹤ 0.05)。27 例患儿MRI 结果异常,其中13 例为基底节/ 丘脑区异常,14 例基底节/ 丘脑区正常。基底节/ 丘脑区异常组与基底节/ 丘脑区正常组PDI 和MDI 均异常的比例[61.5%(8/13)与7.1%(1/14)]、惊厥持续时间[(96.3±24.9)与(67.8±18.6)小时]比较,基底节/ 丘脑区异常组较高(P 值均﹤ 0.05);5 分钟Apgar 评分[(3.6±2.1)与(5.2±1.9)分]、脐血pH 值(6.91±0.21 与7.06±0.18)比较,基底节/ 丘脑区异常组均较低(P 值均﹤0.05)。CDCC 评分异常组与正常组患儿MRI 异常的比例[85.7%(18/21)与16.0%(4/25)]、惊厥持续时间[(76.1±49.9)与(39.9±34.1)小时]比较,CDCC 评分异常组较高;5 分钟Apgar 评分[(5.1±2.9)与(6.6±2.1)分]、脐血pH值[6.92±0.29 与7.05±0.21]、随访依从性好的比例[28.6%(6/21)与60.0%(15/25)]比较,评分异常组均较低(P 值均﹤ 0.05)。 结论 MRI 检查对窒息新生儿神经系统预后评估有一定价值,损伤部位在基底节/ 丘脑区更容易导致运动功能障碍。应关注窒息患儿的神经系统症状和MRI 检查结果,加强对高危新生儿的早期干预。
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Abstract: 【Abstract】 Objective To study the correlation about magnetic resonance imaging (MRI) findings and
relevant clinical data and neurological prognosis of asphyxiated neonates. Methods From January 2013 to December 2015, the full-term newborns with asphyxia were admitted to the neonatology department of
the Affiliated Changzhou Children's Hospital of Nantong University, and totally 46 cases with complete
data were studied. All the neonates were conducted by MRI examination at the age of 6~14 days and their
clinical data were collected. Mental development index (MDI) and psychomotive development index (PDI)
were calculated at the age of 12 months according to children's developmental center of China (CDCC).
The statistical analysis was carried out by t test, χ2 test or Fisher exact probability method. Results 
The severe asphyxia group were higher (all P ﹤ 0.05) than the mild asphyxia group in the proportion
of abnormal CDCC scores of severe asphyxia group and mild asphyxia group[66.7% (16/24) vs 22.7%
(5/22)], the proportion of abnormal MRI [79.2% (19/24) vs 36.4% (8/22)], the rate of abnormal basal
ganglia/thalamus [45.8% (11/24) vs 9.1% (2/22)] and the incidence of hypoxic-ischemic encephalopathy
(HIE) [91.7% (22/24) vs 22.7% (5/22)] . In the 27 cases of neonates with abnormal MRI results, 13
cases were abnormal basal ganglia/thalamus and 14 cases were normal basal ganglia/thalamus. The basal
ganglia/thalamus abnormal group were higher (all P ﹤ 0.05) than the normal basal ganglia/thalamus
in the incidence of abnormal both in PDI and MDI [61.5% (8/13) vs 7.1% (1/14)], the duration of
convulsions [(96.3±24.9) vs (67.8 ± 18.6) hours]; the abnormal basal ganglia/thalamus were lower
than the basal ganglia/thalamus normal group (all P ﹤ 0.05) in the 5 minutes Apgar score [(3.6 ± 2.1)
vs (5.2 ± 1.9) scores] and the umbilical cord blood pH value [(6.91±0.21) vs (7.06±0.18)] . CDCC
score of abnormal group were higher than the normal group in the abnormal MRI rate [(85.7%(18/21)
vs 16.0% (4/25)] and the duration of convulsions [(76.1±49.9) vs (39.9±34.1) hours]; CDCC score
of abnormal group were lower than the CDCC score normal group(all P ﹤ 0.05) in the 5 minutes Apgar
score [(5.1±2.9) vs (6.6±2.1) scores], the umbilical cord blood pH value [(6.92±0.29) vs (7.05±0.21)]
and the rate of good follow-up compliance [28.6% (6/21) vs 60.0% (15/25)]. Conclusions MRI
examination has some value in the evaluation of neurological prognosis in asphyxiated neonates. It is more
likely to cause motor dysfunction if the injured sites are in basal ganglia/thalamus area. The neurological
symptoms and MRI findings should be paid attention in neonates with asphyxiation and the early
intervention in high-risk neonates should be strengthened.

Key words:  Neonates')" href="#">Neonates    Asphyxia| Magnetic resonance imaging| Neurodevelopment| Prognosis
收稿日期:  2018-04-03                出版日期:  2018-10-30      发布日期:  2018-11-20      期的出版日期:  2018-10-30
基金资助: 江苏省妇幼健康重点项目(F201612);常州市科技支撑计划(CE20165027);常州市卫计委重大科技项目(ZD201515)
通讯作者:  李红新http://zt3.cz001.com.cn/2018-08/14/content_3491205.htm    E-mail:  lhx3129@163.com
引用本文:    
华国伟 于敏 江凯华 郑爱斌 李红新. 窒息新生儿磁共振成像与神经系统预后的相关研究[J]. 发育医学电子杂志, 2018, 6(4): 225-230.
HUA Guo-wei, YU Min, JIANG Kai-hua, ZHENG Ai-bin, LI Hong-xin. Research of magnetic resonance imaging and neurological prognosis in asphyxiated neonates. Journal of Developmental Medicine(Electronic Version), 2018, 6(4): 225-230.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2018.04.007  或          http://www.fyyxzz.com/CN/Y2018/V6/I4/225
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