新生儿低血糖症27例临床分析

(广西北海市 ５３６０００)

【关键词】 新生儿;低血糖

新生儿低血糖症指血糖低于正常同龄新生儿的最低血糖值全血标本检测，足月儿3天内血糖

，3天后低于

，小于胎龄儿和早产儿生后3天内血糖

，称为低血糖症[1]。临床表现为阵发性青紫、多汗、苍白、

mmol/L，3天后

反应差、呼吸暂停、嗜睡、拒乳、震颤、抽搐、发绀等表现。选择我院2010—2012年住院新生儿低血糖症27例对其原因及治疗进行分析，现将结果报告如下。 【 Key words】neonatal hypoglycemia;

Neonatal hypoglycemia finger blood glucose below normal neonatal blood glucose in whole blood specimens for the detection of the lowest, full-term infants 3 days blood sugar <1 . 7 mmol/L, 3 days of less than 2 . 2 mmol/L, small for gestational age infants and premature infants born after 3 days blood sugar <1 . 1 mmol/L, 3 days after <2 . 2 mmol/L, called hypoglycemia [1]. Clinical manifestations of paroxysmal sweating, pallor, cyanosis, poor

response, apnea, sleepiness, refused to milk, tremor, convulsions, cyanosis. Selection of Chinese Medicine Hospital of Feicheng city from 2010 to 2012, 27 cases of hospitalized newborn hypoglycemia on its causes and treatment undertakes an analysis, report the result as follows.

1 资料与方法

一般资料 27例中早产儿合并低血糖症者10例，新生儿缺氧缺血性脑病合并低血

糖症者8例，母亲有妊娠期高血糖合并低血糖症者7例。

治疗 对可能发生低血糖者从生后1 h即喂10%葡萄糖7～10 ml/kg每小时1次，

延续3～4次。生后2～3 h提早喂奶，24 h内每小时喂1次。体重低于2 kg者尽快给予7%～10%葡萄糖2～6ml/kg此时葡萄糖浓度不应太高以防止溶液高渗和诱发反跳性高血糖症。出现症状应立即静脉注入27%葡萄糖2～4 ml/kg(小早产儿可用10%葡萄糖液2 ml/kg)，速度为1 ml/min。随后继续滴入10%葡萄糖液，速度为3～7 ml/(kg·h)。葡萄糖滴入速度为7～8 ml/(kg·min)，以维持正常血糖水平。由于糖原贮备不足引起低血糖可将继续滴入的葡萄糖液改为已

～8%葡萄糖液以8～10 mg/(kg·min)的速度输注，24～48h后溶液中应给生～2天，则改为7%葡萄糖液滴注，以后逐渐停止。在血糖稳定以后，每

理需要量氯化钠和氯化钾。症状好转后及时喂奶，同时逐渐减少葡萄糖的量。如血糖天至少测血糖1次。

1．data and method

hypoxic ischemic encephalopathy complicated with hypoglycemia in 8 cases, mothers with gestational hyperglycemia and hypoglycemia in 7 cases. ssible hypoglycemia from 1 h after feeding 10% glucose

7 - 10 ml/kg 1 times per hour, the continuation of 3 ~ 4 times. Born after 2～ 3 h early feeding, 24 h per hour to feed 1 times. Weight below 2 kg as soon as possible to give 7%～ 10% Glucose 2～ 6ml/kg and glucose concentration should not be too high to prevent the solution hypertonic and induced rebound hyperglycemia. The onset of symptoms should immediately vein injection of 27% glucose and 2 ~ 4 ml/kg ( small premature infants are available 10% glucose solution 2 ml/kg ), speed of 1 ml/min. Then continue to drop into the 10% glucose solution, a rate of 3 ～7 ml/ ( kg •h ). Glucose infusion rate of 7 ~ 8 ml/ ( kg •min ), in order to maintain normal blood sugar levels. Due to

glycogen reserve shortage caused by hypoglycemia will continue to drop into

～8% glucose solution in 8 ~ 10 mg/ ( kg •min )

the rate of infusion, 24～ 48h after solution should give the physiological

demand of sodium chloride and potassium chloride. The symptoms improved immediately after feeding, and gradually reduce the quantity of glucose. Such as glucose was >2. 2mmol/L 1 ～2 days, instead of 7% dextrose infusion, then gradually stop. In blood glucose stability after every day at least 1 times, blood glucose.

2 结果

早产儿及缺氧缺血性脑病合并低血糖者治疗3天内血糖稳定且以无症状性低血糖为主。母亲有糖尿病者治疗后7天内血糖渐稳定。临床表现以多汗、震颤为主，反复发作的对低血糖对神经系统发育的影响是肯定的。由于我院23例患儿早期即开始监测血糖，及早开奶喂养，治疗上维持血糖高界，1周内血糖即稳定，经随访均无遗留任何神经系统后遗症。

2 Results

Premature and hypoxic ischemic encephalopathy complicated with hypoglycemia treatment 3 days blood sugar stable and asymptomatic

hypoglycemia mainly. Mother has diabetes treatment within 7 days after the blood glucose is stable. Clinical manifestations of sweating, tremor, repeated episodes of hypoglycemia on the development of nervous system in impact is positive. Due to our hospital 27 cases of children with early blood glucose monitoring, as well as the milk feeding, maintaining blood sugar high group therapy, within 1 weeks of the blood sugar stable, after a follow-up of all without leaving any sequela of nervous system.

3 讨论

早产儿合并低血糖症：原因为糖原和脂肪贮存不足。胎儿肝糖原的贮备主要发生在胎龄最后4～8周，胎儿棕色脂肪的分化是从胎龄26～27周开始，一直延续至生后2～3周，显然早产儿贮存能量少，生后代谢所需能量又相对高，易发生低血糖症，已证实早产儿其糖原合成酶系统的活性较低，糖原的形成障碍而一些重要器官组织的代谢需糖量相对较大[2]。缺氧缺血性脑病合并低血糖症：原因为耗糖过多，因缺氧患儿处于应激状态中，而在应激状态下患儿可迅速利用释放的葡萄糖，使葡萄糖代谢率增高导致低血糖。糖尿病母亲所生新生儿合并低血糖症：原因为高胰岛素血症，糖尿病母亲血糖高，大量的葡萄糖通过胎盘进入胎儿体内，刺激胎儿胰岛β细胞增生，胰岛素分泌增加，发生高胰岛素血症。出生后葡萄糖来源突然中断而胰岛素水平仍较高，易发生低血糖。未治疗的持续性高胰岛素血症性低血糖可引起严重神经系统后遗症或死亡。早期诊断及正确治疗可降低低血糖发生率及改善预后。糖尿病母亲所生新生儿有一定面貌特点表现为患儿肥胖、面色潮红、满月脸、耳廓多毛，可引起医生注意，并进一步询问其母亲是否合并妊娠期糖尿病并进一步对患儿检查，以确定是否合并低血糖症，以便早期诊断和治疗。

3 discuss

Infants with hypoglycemia : reasons for glycogen and fat storage is

insufficient. Fetal hepatic glycogen reserves mainly occurred in the last 4 to 8 weeks of gestational age, fetal brown adipocyte differentiation is a gestational age from 26 to 27 weeks, until 2 to 3 weeks after birth, apparently in preterm infants after birth less energy storage, metabolic energy required by the relatively high, easy occurrence of hypoglycemia, have card the premature infants glycogen synthase system of lower activity, glycogen formation

disorder and some important organs and tissues of the metabolism of sugar with relatively large [2]. Hypoxic ischemic encephalopathy complicated with hypoglycemia: reasons for the excessive sugar consumption, due to lack of children in a state of stress, and in the condition of stress in children can be rapidly using the release of glucose, the glucose metabolic rate increased

hypoglycemia. Born from diabetic mothers neonates with hypoglycemia: due to hyperinsulinemia, hyperglycemia of diabetic mother, large amounts of glucose enter the fetus through the placenta, stimulation of fetal islet cell hyperplasia, increased insulin secretion, occurrence of hyperinsulinemia. After the birth of glucose and insulin levels in sudden interrupt source is still high, easy

occurrence of hypoglycemia. Without treatment of persistent hyperinsulinemic hypoglycemia can cause severe neurologic sequelae or death. Early diagnosis and proper treatment can reduce the incidence of hypoglycemia and improved prognosis. Born from diabetic mothers newborns have certain appearance characteristics of children obesity, flushing, moon face, ear hairy, can cause the attention of clinicians, and further asked whether the mother with

gestational diabetes mellitus and further on children examination, to determine whether the combined low blood sugar disorder, so early diagnosis and treatment

【参考文献】

1 杨锡强，易著文.儿科学,第6版.北京:人民卫生出版社,2004.

2 金汉珍,黄德珉,官希吉.实用新生儿学.北京:人民卫生出版社,2003.

【Reference】.

1 Yang Xiqiang, Yi Wen. Pediatrics, Sixth Edition . Beijing: People's Medical Publishing House, 2004

2 Jin Hanzhen, Huang Demin, officer higi. The Journal of practical medicine . Beijing: People's Medical Publishing House, 2003