小儿心肺复苏后脑血流监测的临床研究  

A clinical study on monitoring cerebral blood flow of children with cardiopulmonary resuscitation

作　　者：钱素云[1] 李云娟[1] 王雷[1] 樊寻梅[1] 尹河华[1] 

机构地区：[1]首都医科大学附属北京儿童医院急救中心,北京100045

出　　处：《中华急诊医学杂志》2005年第5期377-379,共3页Chinese Journal of Emergency Medicine

基　　金：北京市科技新星计划资金资助(952872900)

摘　　要：目的探讨心肺复苏后患儿脑血流变化特点及与预后的关系。方法经颅多普勒超声动态监测心肺复苏后的患儿45例,以左侧大脑中动脉和颈内动脉颅外段为靶血管,观察频谱形态和血流速度,同时做Glasgow昏迷评分。根据经颅多普勒超声频谱形态将患儿分为低灌流组、高灌流组和大致正常组。结果低灌流组和高灌流组最高G1asgow评分明显低于大致正常组(P<0.01);而因深昏迷放弃治疗和死亡数明显高于大致正常组(P<0.01)。低灌流组随病程进展脑血流无明显改善;高灌流组2例随病情加重转变为低灌流型:存活患儿随病情好转经颅多普勒超声频谱逐渐趋于正常。结论经颅多普勒超声监测心肺复苏后患儿脑血流变化有助于了解脑灌流状况,评估预后,并指导临床治疗。Objective To explore the characteristics of cerebral blood flow,and its effeet on prognosis of children with cardiopulmonary resuscitation.Methods The waveforms and cerebral blood flow velocities of left middle cerebral artery and extracranial internal carotid artery were monitored by transcranial doppler(TCD)in 45 children after resuscitation.Glasgow coma score(GCS)was estimated at the same time.They were divided into three groups according to the diastolic blood flow velocities:low perfusion group,high perfusion group and near-normal perfusion group.Results In both low and high perfusion groups,GCS were significantly lower,and numbers of the dead and withdrawing treatment patients were more than that of near-normal perfusion group(P<0.01).No significant changes of cerebral blood flow velocities in the low perfusion group was observed,but two patients whose TCD waveforms changed from high perfusion into low perfusion as their clinical state was worse.TCD waveforms and cerebral blood flow velocities became more and more near normal in all survival children.Conclusion TCD monitoring is a useful in estimating cerebral perfusion and outcome of children with cardiopulmonary resuscitation.It is also helpful for guiding treatment of resuscitation children.

关 键 词：复苏后 脑血流监测 心肺 临床研究 GLASGOW昏迷评分 GLASGOW评分 经颅多普勒超声监测 颈内动脉颅外段 小儿 超声动态监测 频谱形态 大脑中动脉 脑血流变化 正常组 变化特点 血流速度 放弃治疗 病程进展 超声频谱 病情加重 

分 类 号：R72[医药卫生—儿科]