产前不同疗程激素治疗对早产儿脑发育的影响

摘要

Objective To investigate influence of antenatal hormonotherapy by different treatment courses on brain development of premature infant. Methods A total of 107 premature infants aging 28~34 weeks were divided by antenatal dexamethasone administration status in mothers into control group (n=32), single course group (n=45) and multiple courses group (n=30). The control group received no dexamethasone;the single course group received 6 mg of dexamethasone by intramuscular injection twice a day for 1 course as 2 d;the multiple courses group received dexamethasone for more than 1 course. Neonatal behavioral neurological assessment (NBNA) with 20 items was applied when corrected gestational age was at expected date of confinement. Infantile intelligent development evaluation was made by mental development index (MDI) and psychomotor development index (PDI) of Beylay infant development scale when corrected gestational age was at postnatal 6 and 12 months. Results The single course group had much higher NBNA score when corrected gestational age was at expected date of confinement than the control group and multiple courses group (P<0.05). The single course group also had higher MDI and PDI of Beylay infant development scale during corrected gestational age at postnatal 6 and 12 months than the control group and the multiple courses group (P<0.05). Conclusion Implement of antenatal dexamethasone for a single course can improve short and long-term prognosis of premature infant, while multiple courses of dexamethasone may have certain negative influence on brain development of premature infant. Thus it requires necessary caution in clinical application.%目的：探讨产前不同疗程激素治疗对早产儿脑发育的影响。方法28~34周的早产儿107例,按母亲产前应用地塞米松的情况分为对照组(n=32)、单疗程组(n=45)、多疗程组(n=30)。对照组未用地塞米松；单疗程组应用地塞米松6 mg,2次/d,肌内注射,2 d为1个疗程,仅用1个疗程；多疗程组应用地塞米松1个疗程以上。纠正胎龄至预产期时行新生儿20项行为神经测定(NBNA),纠正胎龄至出生6、12个月时采用Beylay婴幼儿发展量表的智力发展指数(MDI)和精神运动发展指数(PDI)进行婴幼儿期智能发育评估。结果纠正胎龄达预产期时单疗程组NBNA评分明显高于对照组及多疗程组(P<0.05)。纠正胎龄至出生6、12个月行Beylay婴幼儿发展量表检测,单疗程组MDI和PDI均明显高于对照组及多疗程组(P<0.05)。结论产前单疗程地塞米松治疗可改善早产儿近、远期预后；产前多疗程地塞米松治疗对早产儿脑发育有一定的不良影响,临床应用时应提高警惕。