早产儿脑额叶发育及其影响因素的研究

目的 应用三维超声技术探讨早产儿脑额叶发育及其影响因素.方法 选取222例无严重脑损伤的早产儿,应用三维超声对额叶体积进行测量.随访中分别在矫正年龄至40周、1个月、3个月、6个月及以后的时间进行全面的神经系统及体格发育检查,6个月内进行体积跟踪测定.结果 早产儿出生时额叶体积随胎龄的增加而增长.生后出现追赶性生长,在矫正年龄40周及1个月时增长最为迅速,达到甚至超过了足月儿,在以后的生长中逐渐落后于正常足月儿.早产儿成熟度越低,额叶体积越小,矫正年龄40周及以后的时间点,各组额叶体积数值相当,组间差异无统计学意义(P＞0.05).宫内外营养情况较差的早产儿额叶体积的生长始终落后于生长发育正常的早产儿(P＜0.05).额叶体积生长严重落后的早产儿出现神经发育重度异常的几率较正常早产儿明显升高(50%).结论 早产儿额叶体积随胎龄增长而增加,生后短期内出现追赶性生长,宫内外营养状况影响额叶发育,体积测定值的异常与神经发育异常有关.

Study on the development of frontal lobe in preterm infants and its affected factors

Objectives To explore the development of frontal lobe in preterm infants and its affected factors with three-dimensional(3D)ultrasonic methods.Methods 222 preterm infants without sever brain injury were recruited in the study.The volumes of frontal lobes were measured with 3D ultrasound.The infants received the general and nervous system examination as well as the volume tracked measurement at the corrected gestational age of 40 weeks,one month,three months,six months after birth.Results The volumes of frontal lobes increased with the advancing gestational age and continued to grow after birth.In preterm infants,the volume showed catch-up growth after birth.And the velocity was the most rapid at the corrected gestational age of 40 weeks and 1 month after birth and even reached or exceeded that in full-term infants.However,it gradually lagged behind the full-term infants in the subsequent time.The lower the maturity of preterm infants,the smaller the frontal lobe volume.The frontal lobe volume between all gestational age groups was comparable at the corrected gestational age of 40 weeks and the subsequent time points,and the differences among different gestational age groups were not significant(P > 0.05).The frontal lobe volumes in the pre-term infants with a poorer intra-and extra-uterine nutritional status in different gestational ages were lagged behind the age-matched normal preterm infants(P < 0.05=.In comparison with the normal preterms infant,the incidence of severe abnormalities of nervous system markedly increased in the preterm infants with severely lagged growth of frontal lobe volume(50%).Conclusions Frontal lobe volumes increased with the gestational ages proportionately and showed the catch-up growth after birth in a short time.The poorer intra-and extra-uterine nutritional status influenced the development of frontal lobe volume.The degree of the frontal lobe abnormal volumes was related to the neurological developmental abnormalities in preterm infants.