輕度腦室周圍—腦室內(nèi)出血和重度腦室旁白質(zhì)損傷對(duì)早產(chǎn)兒排尿方式影響的研究
發(fā)布時(shí)間：2019-06-19 12:22
【摘要】：隨著新生兒診療技術(shù)的發(fā)展，早產(chǎn)兒存活率有了很大的提高，早產(chǎn)兒疾病也越來越引起了人們的重視。腦損傷是早產(chǎn)兒常見的神經(jīng)系統(tǒng)疾病，有很多表現(xiàn)形式，其中腦室周圍-腦室內(nèi)出血（Peri-intraventricular hemorrhage,PIVH)和腦室旁白質(zhì)損傷(Periventricular White Matter Injury, PWMI)是早產(chǎn)兒腦損傷最為常見的類型。當(dāng)前對(duì)這兩種腦損傷的研究主要局限在為發(fā)病機(jī)制，診斷治療及預(yù)后方面，這兩種腦損傷對(duì)早產(chǎn)兒排尿方式影響的研究尚未多見，有待探討。 排尿是一個(gè)復(fù)雜的神經(jīng)反射過程，需要位于脊髓腰骶部的低級(jí)排尿中樞和位于脊髓以上的高級(jí)排尿中樞共同參與完成，脊髓以上控制排尿的高級(jí)神經(jīng)中樞主要包括腦橋儲(chǔ)尿和排尿中樞，中腦水管周圍灰質(zhì)，丘腦及大腦皮質(zhì)的若干區(qū)域等，這些部位間存在著廣泛的神經(jīng)纖維聯(lián)系。腦功能成像研究發(fā)現(xiàn)成人排尿時(shí)上訴這些部位的活動(dòng)顯著增強(qiáng)，提示高級(jí)神經(jīng)系統(tǒng)調(diào)節(jié)成人排尿反射的整個(gè)過程。腦損傷對(duì)成人排尿的影響是顯著的，腦血管疾病如腦梗塞及腦出血多會(huì)引起成人排尿方式的改變，如出現(xiàn)尿頻，尿急等。腦室旁白質(zhì)損傷的成年患者多合并有顯著的膀胱功能障礙，提示腦室旁白質(zhì)也在排尿反射中發(fā)揮重要作用。 新生兒排尿特點(diǎn)主要包括排尿次數(shù)多，每次尿量少，排尿后存在殘余尿，間斷排尿，睡眠中排尿等。對(duì)足月兒的自由排尿觀察發(fā)現(xiàn)足月兒在排尿時(shí)存在明顯的覺醒征象如從睡眠中醒來，肢體活動(dòng)等，腦電圖檢查顯示足月兒在排尿時(shí)有腦電波的改變，提示大腦皮質(zhì)及高級(jí)神經(jīng)中樞已參與了足月兒的排尿反射。對(duì)早產(chǎn)兒的自由排尿觀察發(fā)現(xiàn)早產(chǎn)兒排尿時(shí)只有部分存在覺醒征象，多數(shù)排尿發(fā)生在睡眠時(shí)，腦電圖檢查顯示早產(chǎn)兒在排尿時(shí)腦電波并未發(fā)生明顯改變，提示相對(duì)足月兒排尿，早產(chǎn)兒排尿表現(xiàn)得更為不成熟，高級(jí)神經(jīng)中樞在早產(chǎn)兒排尿反射中發(fā)揮的作用還有待探討。 早產(chǎn)兒腦室周圍-腦室內(nèi)出血的出血部位位于側(cè)腦室腹外側(cè)尾狀核頭部，臨近多個(gè)脊髓以上高級(jí)排尿中樞，可通過多種形式對(duì)這些排尿中樞產(chǎn)生影響，輕度出血多不伴有腦室擴(kuò)張，而重度出血多伴有腦室擴(kuò)張，重度出血患兒病情為重，所以未納入本研究。根據(jù)顱腦超聲檢查腦室旁強(qiáng)回聲的持續(xù)時(shí)間，可將早產(chǎn)兒腦室旁白質(zhì)損傷分為輕度損傷，強(qiáng)回聲持續(xù)時(shí)間少于7天和重度損傷，強(qiáng)回聲持續(xù)時(shí)間多于14天，重度腦室旁白質(zhì)損傷更能反映高級(jí)神經(jīng)中樞在早產(chǎn)兒排尿反射中發(fā)揮的作用。 本研究對(duì)胎齡32-36周輕度腦室周圍-腦室內(nèi)出血早產(chǎn)兒，，重度腦室旁白質(zhì)損傷早產(chǎn)兒及正常早產(chǎn)兒實(shí)施了連續(xù)8小時(shí)自由排尿觀察并收集多項(xiàng)排尿參數(shù)，通過比較輕度腦室周圍-腦室內(nèi)出血早產(chǎn)兒與正常早產(chǎn)兒，重度腦室旁白質(zhì)損傷早產(chǎn)兒與正常早產(chǎn)兒排尿參數(shù)的差異，發(fā)現(xiàn)這兩種形式的腦損傷對(duì)早產(chǎn)兒排尿方式的影響是顯著的，提示高級(jí)神經(jīng)中樞已參與了胎齡較大早產(chǎn)兒的排尿反射活動(dòng)。 目的： 探討輕度腦室周圍-腦室內(nèi)出血（PIVH）和重度腦室旁白質(zhì)損傷（PWMI）對(duì)早產(chǎn)兒排尿方式的影響。 方法： 本研究包括55例胎齡在32-35周適于胎齡早產(chǎn)兒，均在出生后2-7天內(nèi)行顱腦超聲檢查，根據(jù)是否發(fā)現(xiàn)輕度PIVH或重度PWMI將其分為輕度PIVH組（20例），重度PWMI組（19例）和正常組（16例），對(duì)輕度PIVH組，重度PWMI組和正常組早產(chǎn)兒在其出生后日齡為9-15天時(shí)進(jìn)行連續(xù)8小時(shí)自由排尿觀察，記錄每位早產(chǎn)兒的排尿次數(shù)，每次排尿量，殘余尿量，清醒排尿及間斷排尿，通過統(tǒng)計(jì)學(xué)軟件比較輕度PIVH早產(chǎn)兒和正常早產(chǎn)兒排尿參數(shù)以及重度PWMI早產(chǎn)兒和正常早產(chǎn)兒排尿參數(shù)有無差異。 結(jié)果： 輕度PIVH組早產(chǎn)兒膀胱排空比例((26±11)%vs.(34±7)%,P=0.02)，清醒排尿比例((34±11)%vs.(42±7)%,P=0.01)顯著低于正常組早產(chǎn)兒，殘余尿量((P25=0ml.,P50=2ml.,P75=3ml.)vs.(P25=0ml.,P50=2ml.,P75=2ml.),P=0.02)顯著高于正常組早產(chǎn)兒，輕度PIVH組與正常組早產(chǎn)兒在排尿次數(shù)(（6.6±1.1）vs.(7.0±1.1),P=0.29)，每次排尿量((16.4±5.4)ml.vs.(15.9±5.3)ml.,P=0.43)及間斷排尿(50%vs.44%,P=0.75)比例方面無顯著性差異。 重度PWMI組早產(chǎn)兒排尿次數(shù)((5.1±1.0)vs.(7.0±1.1), P0.01),清醒排尿比例(23±11)%vs.(42±7)%,P0.01)及排空排尿比例((P25=16%,P50=20%,P75=28%)vs.(P25=28%,P50=33%,P75=40%),P0.01)顯著低于正常組早產(chǎn)兒，每次排尿量(19.9±6.6)ml.vs.(15.9±5.3)ml.,P0.01）及殘余尿量（(P25=1ml.,P50=3ml.,P75=3ml.）vs.(P25=0ml.,P50=2ml.,P75=2ml.),P0.01)顯著高于正常組早產(chǎn)兒，重度PWMI組與正常組的間斷排尿比例(52%vs.44%, P=0.74)無顯著性差異。 結(jié)論： 1.輕度PIVH對(duì)胎齡較大早產(chǎn)兒排尿時(shí)的意識(shí)狀態(tài)及膀胱排空具有顯著影響。 2.重度PWMI對(duì)胎齡較大早產(chǎn)兒整體排尿方式具有顯著影響，主要表現(xiàn)為排尿次數(shù)減少及每次排尿量增多。 3.高級(jí)神經(jīng)中樞已參與了胎齡較大早產(chǎn)兒的排尿反射。 4.腦干以上高級(jí)神經(jīng)中樞對(duì)胎齡較大早產(chǎn)兒排尿反射發(fā)揮易化作用。
[Abstract]:With the development of the newborn's diagnosis and treatment technology, the survival rate of the premature infant is greatly improved, and the premature infant's disease has become more and more important. Brain injury is a common nervous system disease in premature infants. There are many manifestations, in which the periventricular-intraventricular hemorrhage (PIVH) and the periventricular white matter (PWMI) are the most common types of brain damage in premature infants. The current research on these two kinds of brain damage is mainly limited to the pathogenesis, diagnosis and treatment and the prognosis. Urination is a complex process of neuroreflection, which is required to be located in the low-level micturition center of the lumbar spinal part of the spinal cord and the high-level micturition center above the spinal cord. The high-level nerve center for controlling urination above the spinal cord mainly includes the brain-bridge urine storage and the urination. A number of areas, such as the periaqueductal gray matter, the thalamus, and the cerebral cortex. System. The brain functional imaging study found that the activity of these sites was significantly enhanced in adult urination, suggesting that the high-level nervous system regulates the whole of the adult micturition reflex Cheng. The effect of brain injury on the urination of adults is significant. The cerebrovascular disease, such as cerebral infarction and cerebral hemorrhage, can cause the change of the adult micturition, such as the occurrence of frequent micturition and urgency. In adult patients with periventricular leukaiosis, there are significant bladder dysfunction, suggesting that the periventricular white matter also plays an important role in the reflex of micturition. The characteristics of urination in the newborn mainly include more frequent urination, less urine volume, residual urine after urination, intermittent urination, and sleep. Urination and the like. The free micturition of the foot of the foot is found to have obvious wakefulness in urination, such as waking up from the sleep, limb activity, etc., and the electroencephalogram examination shows that the baby's brain wave has a brain wave during urination. The changes of the cerebral cortex and the high-level nerve center have been involved in the row of the foot-moon. Urine reflex. The free micturition of premature infants showed that only a part of the premature infants had an awakening sign, most of the micturition occurred in the sleep, and the EEG examination showed that the brain waves did not change significantly at the time of urination, indicating the relative foot-months. The effect of urination and urination in premature infants is more immature, and the high-level nerve center plays an important role in the reflex of urination in premature infants. To be discussed. The bleeding part of the periventricular-intraventricular hemorrhage of the premature infant is located in the head of the lateral lateral caudate nucleus of the lateral ventricle. It is close to the high-grade micturition center of the multiple spinal cord. It can have the effect on these micturition centers in a variety of forms. The ventricle is dilated, and the severe bleeding is accompanied by ventricular dilatation, and the condition of the child with severe bleeding is heavy, so it is not It is included in this study. The periventricular leukaiosis of premature infants can be divided into mild lesions, a strong echo duration of less than 7 days and a severe injury, a strong echo duration, More than 14 days, severe intraventricular white matter damage can reflect the high-level nerve center in the early-term micturition reflex of premature infants The effect of this study on premature and severe intraventricular hemorrhage of premature and severe intraventricular leukaiosis in the 32-36 weeks of fetal age was observed and received in a continuous 8-hour free-micturition. The effect of these two forms of brain injury on the urination of premature infants was found by comparing the difference between the early and normal preterm infants, the severe intraventricular leukaiosis, and the normal prematurity of premature infants. The effect is significant, suggesting that the high-level nerve center has been involved in the older preterm infants. micturition Reflex activity. Objective: To investigate the periventricular hemorrhage (PIVH) and the severe ventricular leukaiosis (PWMI) in the periventricular-intraventricular hemorrhage (PIVH). prematurity Methods: The study included 55 cases of premature infants with gestational age of 32-35 weeks, all of which underwent a head-and-brain ultrasound examination within 2-7 days after birth, and it was divided into mild PIVH group (20 cases), severe PWMI group (19 cases) and normal group according to whether mild PIVH or severe PWMI was found. The group (16 cases), treated with mild PIVH group, severe PWMI group and normal group of premature infants at the age of 9-15 days after birth for 8 hours to observe, record the number of micturition of each premature infant, each time the amount of urination , residual urine volume, awake urination, and intermittent urination, comparing mild PIVH premature and normal preterm infant urination parameters with statistical software, and severe PWMI preterm birth Er and Zheng The results showed that the ratio of urinary bladder emptying (26%11)% vs. (34%7)%, P = 0.02), and the ratio of conscious micturition (34%11)% vs. (42%7)%, P = 0.01) were significantly lower than that of positive prematurity. normal group of premature infants, residual urine Quantity (P25 = 0 m l.,P50=2ml.,P 75=3ml.)v s.(P25=0m L., P50 = 2 ml., P75 = 2 ml.), P = 0.02) was significantly higher in the normal group than in the normal group, and the number of micturition (6.6% 1.1) vs. (7.0% 1.1) vs. (7.0% 1.1), P = 0.29) in the mild PIH group and the normal group, each time (16.4% 5.4)
本文編號(hào)：2502345
[Abstract]:With the development of the newborn's diagnosis and treatment technology, the survival rate of the premature infant is greatly improved, and the premature infant's disease has become more and more important. Brain injury is a common nervous system disease in premature infants. There are many manifestations, in which the periventricular-intraventricular hemorrhage (PIVH) and the periventricular white matter (PWMI) are the most common types of brain damage in premature infants. The current research on these two kinds of brain damage is mainly limited to the pathogenesis, diagnosis and treatment and the prognosis. Urination is a complex process of neuroreflection, which is required to be located in the low-level micturition center of the lumbar spinal part of the spinal cord and the high-level micturition center above the spinal cord. The high-level nerve center for controlling urination above the spinal cord mainly includes the brain-bridge urine storage and the urination. A number of areas, such as the periaqueductal gray matter, the thalamus, and the cerebral cortex. System. The brain functional imaging study found that the activity of these sites was significantly enhanced in adult urination, suggesting that the high-level nervous system regulates the whole of the adult micturition reflex Cheng. The effect of brain injury on the urination of adults is significant. The cerebrovascular disease, such as cerebral infarction and cerebral hemorrhage, can cause the change of the adult micturition, such as the occurrence of frequent micturition and urgency. In adult patients with periventricular leukaiosis, there are significant bladder dysfunction, suggesting that the periventricular white matter also plays an important role in the reflex of micturition. The characteristics of urination in the newborn mainly include more frequent urination, less urine volume, residual urine after urination, intermittent urination, and sleep. Urination and the like. The free micturition of the foot of the foot is found to have obvious wakefulness in urination, such as waking up from the sleep, limb activity, etc., and the electroencephalogram examination shows that the baby's brain wave has a brain wave during urination. The changes of the cerebral cortex and the high-level nerve center have been involved in the row of the foot-moon. Urine reflex. The free micturition of premature infants showed that only a part of the premature infants had an awakening sign, most of the micturition occurred in the sleep, and the EEG examination showed that the brain waves did not change significantly at the time of urination, indicating the relative foot-months. The effect of urination and urination in premature infants is more immature, and the high-level nerve center plays an important role in the reflex of urination in premature infants. To be discussed. The bleeding part of the periventricular-intraventricular hemorrhage of the premature infant is located in the head of the lateral lateral caudate nucleus of the lateral ventricle. It is close to the high-grade micturition center of the multiple spinal cord. It can have the effect on these micturition centers in a variety of forms. The ventricle is dilated, and the severe bleeding is accompanied by ventricular dilatation, and the condition of the child with severe bleeding is heavy, so it is not It is included in this study. The periventricular leukaiosis of premature infants can be divided into mild lesions, a strong echo duration of less than 7 days and a severe injury, a strong echo duration, More than 14 days, severe intraventricular white matter damage can reflect the high-level nerve center in the early-term micturition reflex of premature infants The effect of this study on premature and severe intraventricular hemorrhage of premature and severe intraventricular leukaiosis in the 32-36 weeks of fetal age was observed and received in a continuous 8-hour free-micturition. The effect of these two forms of brain injury on the urination of premature infants was found by comparing the difference between the early and normal preterm infants, the severe intraventricular leukaiosis, and the normal prematurity of premature infants. The effect is significant, suggesting that the high-level nerve center has been involved in the older preterm infants. micturition Reflex activity. Objective: To investigate the periventricular hemorrhage (PIVH) and the severe ventricular leukaiosis (PWMI) in the periventricular-intraventricular hemorrhage (PIVH). prematurity Methods: The study included 55 cases of premature infants with gestational age of 32-35 weeks, all of which underwent a head-and-brain ultrasound examination within 2-7 days after birth, and it was divided into mild PIVH group (20 cases), severe PWMI group (19 cases) and normal group according to whether mild PIVH or severe PWMI was found. The group (16 cases), treated with mild PIVH group, severe PWMI group and normal group of premature infants at the age of 9-15 days after birth for 8 hours to observe, record the number of micturition of each premature infant, each time the amount of urination , residual urine volume, awake urination, and intermittent urination, comparing mild PIVH premature and normal preterm infant urination parameters with statistical software, and severe PWMI preterm birth Er and Zheng The results showed that the ratio of urinary bladder emptying (26%11)% vs. (34%7)%, P = 0.02), and the ratio of conscious micturition (34%11)% vs. (42%7)%, P = 0.01) were significantly lower than that of positive prematurity. normal group of premature infants, residual urine Quantity (P25 = 0 m l.,P50=2ml.,P 75=3ml.)v s.(P25=0m L., P50 = 2 ml., P75 = 2 ml.), P = 0.02) was significantly higher in the normal group than in the normal group, and the number of micturition (6.6% 1.1) vs. (7.0% 1.1) vs. (7.0% 1.1), P = 0.29) in the mild PIH group and the normal group, each time (16.4% 5.4)
ml. vs. . (15.9-5.3) ml., P = 0.43) and intermittent urination (50% vs.44 There was no significant difference in the ratio of%, P = 0.75. The number of micturition of premature infants in the severe PWMI group ((5.1% 1.0) vs. (7.0% 1.1), P 0.01), the ratio of clear urination (23%11)% vs. (42%7)%, P 0.01) and the proportion of emptying (P25 = 16%, P50 = 20%, P75 = 28%) vs. (P25 (= 28%, P50 = 33%, P75 = 40%), P 0.01) was significantly lower than that of the normal group, each time the amount of urine (19.9% 6.6)
ml. Vs. (15.9鹵5.3)ml. (P0.01) and disabled Remaining urine volume (P25 = 1ml.,P50=3ml. ,P75=3ml. )vs.(P25= 0 ml., P50 = 2 ml., P75 = 2 ml.), P 0.01) was significantly higher than that of the normal group of premature, severe PWMI and normal groups (52 %vs (44%, P = 0.74) no significant difference. Conclusion:1. Mild PIVH vs. 2. The effect of severe PWMI on the whole micturition of premature infants with large gestational age The formula has a remarkable effect, and is mainly characterized in that the number of micturition is reduced and the amount of urine is discharged each time 3. The high-level nerve center has been involved in the micturition reflex of the older preterm infants.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R722.6
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