床旁彩色多普勒超声在足月新生儿缺氧缺血性脑病早期诊断中的应用  

Application of Color Doppler Ultrasonography by Bed Side in the Early Diagnosis of Hypoxic-Ischemic Encephalopathy in Full Term Neonates

作　　者：苏一巾[1] 杜联芳[1] 夏瑾[2] 方敏[2] 徐先明[2] 洪建国[3] 

机构地区：[1]上海交通大学附属第一人民医院超声科,上海200080 [2]上海交通大学附属第一人民医院产科,上海200080 [3]上海交通大学附属第一人民医院儿科,上海200080

出　　处：《实用儿科临床杂志》2008年第12期923-925,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨床旁彩色多普勒超声在足月新生儿HIE早期诊断中的应用价值。方法对35例临床诊断为轻中度HIE的住院足月新生儿在出生24、48和72h连续3次进行床旁彩色多普勒超声检查,观察患儿脑实质回声的变化,测量其大脑前动脉、大脑中动脉和大脑后动脉的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI)。健康对照组为40例同期本院产科出生的健康足月新生儿。结果1.脑实质回声的变化:健康对照组新生儿出生24～72h脑实质回声均匀,脑内结构显示清晰、细腻。轻度HIE组新生儿出生24h脑实质回声不均匀,呈点状或小片状回声增强,出生48h脑实质回声接近正常。中度HIE组出生24h脑实质回声呈散在或广泛回声增强增粗,脑内结构显示粗糙,出生48～72h脑实质回声仍呈散在回声增强。2.大脑动脉血流速度的变化:出生24、48h轻中度HIE组Vs、Vd均显著低于健康对照组,组间比较均有显著差异(Pa<0.01),但出生72h比较无显著差异(Pa>0.05)。3.RI的变化:出生24、48h轻中度HIE组均高于健康对照组,组间比较均有显著差异(Pa<0.01),出生72h轻中度HIE组、健康对照组组间比较均无显著差异(P>0.05)。结论床旁彩色多普勒超声简便、易行,有助于足月新生儿HIE的早期诊断。Objective To explore the value of color doppler ultrasonography by bed side in the early diagnosis of HIE in full term neonates. Methods The changes of cerebral parenchymal and cerebral arterial blood stream parameter On 35 eases of neonates clinically diagnosed HIE of mild and moderate degree and 40 cases of normal newborns on the 24,48 and 72 hours after birth were observed by color doppler ultrasonography by bed side. Results 1. The cerebral parenchyma was even echo in normal newborns, but it was maldistributed and reinforced in mild asphyxia neonates and it was more serious in moderate degree. The echo of cerebral parenchyma in mild degree was near normal in 48 hours after birth, while the echo of cerebral parenchyma in moderate degree was still maldistributed and reinforced in 48 and 72 hours afterbirth. 2. There was obvious changes in the cerebral arterial blood stream parameter and hemodynamics of the asphyxia newborns compared with normals. The systolic peak velocity （Vs） and end diastolic velocity （Vd） of the cerebral arteries in mild and moderate degree were obviously lower than that of control group in 24,48 hours after birth（P 〈0.01 ）. Vs and Vd in mild and moderate degree were recovered in 48 hours after birth. But there was no obvious differenses in 72 hours among 3 groups （Pa〉 0.05 ）. 3. Resistance index （RI） of the cerebral arteries in mild and moderate degree were higher than that of control group in 24,48 hours after birth（ Pa〈0. 01）. But there was no obvious differenses in 72 hours among 3 groups （ Pa〉 0.05 ）. Conclusion Color doppler ultrasonography by bed side is a convenient, noninvasive method for diagnosing HIE.

关 键 词：婴儿 新生 缺氧缺血性脑病 早期诊断 床旁彩色多普勒超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R722.1[医药卫生—诊断学]