小儿心肺复苏后脑血流及脑血管二氧化碳反应性的变化  

Changes of cerebral blood flow and carbon dioxide reactivity of cerebral vessels in children after cardiopulmonary resuscitation

作　　者：李云娟[1] 钱素云[1] 刘红[1] 王雷[1] 尹河华[1] 高恒淼[1] 杨明[1] 李峥[1] 李克华[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》2006年第8期724-727,共4页Chinese Journal of Emergency Medicine

摘　　要：目的观察心肺复苏后小儿脑血流变化特点,与脑损伤程度及预后的关系,脑血管二氧化碳收缩反应性变化。方法经颅多普勒超声(transcranial Doppler,TCD)动态监测心肺复苏后患儿35例,以左侧大脑中动脉(middle cerebral artery,MCA)和颈内动脉颅外段(extracranial internal carotid artery,EICA)为靶血管,根据复苏后12～24 h TCD频谱形态将患儿分为低灌流组、高灌流组和大致正常组。观察血流速度、脉动指数和MCA/EICA平均流速比值,同时做Glasgow昏迷评分。选择三组中气管插管机械通气的患儿26例,采用过度通气法进行脑血管CO_2收缩反应测定。结果低灌流组和高灌流组患儿最高Glasgow评分明显低于大致正常组(P＜0．05)；而死亡和放弃治疗自动出院病例数明显高于大致正常组(P＜0．01)。低灌流、高灌流组患儿的脑血管CO_2收缩反应性明显低于大致正常组患儿(P＜0．05)。结论TCD监测心肺复苏后患儿脑血流变化有助于了解脑灌流,评估预后,评价脑血管二氧化碳反应性；在缺乏脑血流监测的情况下,复苏后患者常规应用过度通气降颅压有加重脑缺氧的可能。Objective To observe the changes of cerebral blood flow velocities and carbon dioxide （ CO2 ） reactivity of cerebral vessels in children after cardiopulmonary resuscitation, and the relationship between the changes of cerebral blood flow and outcome. Methods The waveforms, cerebral blood flow velocities of left middle cerebral artery and extracranial internal carotid artery were monitored by Transcranial Doppler （TCD） in 35 post-resuscitation children. 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. CO2 reactivity of cerebral vessels was induced by hyperventilation in 26 children under ventilation. Results In both low and high perfusion groups, GCS and CO2 reactivity of cerebral vessels were significantly lower than that of near-normal perfusion group （ P 〈 0.05） ; the numbers of died and withdrawing treatment patients were significantly higher than that of near-normal perfusion group （P 〈 0.01 ）. Conclusion TCD monitoring is a useful technique for estimating cerebral perfusion, outcome and CO2 reactivity of cerebral vessels of children after cardiopulmonary resuscitation. A secondary ischemic event may be caused by a forced hyperventilation therapy in the condition without TCD monitoring in post-resuscitation patients.

关 键 词：脑血流 心肺复苏 经颅多普勒超声 二氧化碳收缩反应性 

分 类 号：R720.597[医药卫生—急诊医学]