缺氧性心肌损伤对新生儿脑血流动力学和脑组织氧饱和度的影响  

Effect of hypoxic myocardial injury on neonatal cerebral hemodynamics and brain tissue oxygen saturation

作　　者：汤泽中[1] 周丛乐[1] 姜毅[1] 侯新琳[1] 王红梅[1] 

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中华围产医学杂志》2012年第12期716-719,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的了解新生儿缺氧性心肌损伤和心动过缓对脑血流动力学和脑组织氧饱和度（regional oxygen saturation，rSO2）的影响，为新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）急性期的治疗提供病理生理学依据。方法研究对象为2005年12月至2008年12月期间，北京大学第一医院新生儿科收治的49例足月HIE患儿，其中18例合并心肌损伤，31例未合并心肌损伤；对照组为同期住院的50例黄疸新生儿（总胆红素〈256μmol／L）。出生后3～7d，采用多普勒超声检测大脑前动脉的收缩期流速（systolicvelocity，Vs）、舒张期流速（diastolic velocity，Vd）和阻力指数（resistance index，RI），采用近红外光谱测定技术检测脑rSO2，3组间数据比较采用方差分析，两两比较采用LSD法。另纳入20例不同原因导致心动过缓的患儿，采用配对t检验比较心动过缓治疗前后脑rSO2的变化。结果（1）HIE合并心肌损伤组、未合并心肌损伤组和对照组平均Vs分别为（19．35±5．13）、（29．35±4．28）和（32．62±7．47）cm／s，平均Vd分别为（6．43±2．98）、（11．21±3．16）和（11．50±3．03）cm／S，平均R1分别为0．68±0．10、0．62±0．03和0．64±0．06，平均脑rSO2分别为（52．4±2．8）％、（54．6±3．1）％和（62．1±1．9）％，各指标3组间比较差异均有统计学意义（F分别为29．999、19．393、5．283、137．952，P〈0．01）。与对照组和HIE未合并心肌损伤组比较，HIE合并心肌损伤组患儿Vs和Vd均降低，RI增高，脑rSO2降低，差异均有统计学意义（P〈0．05）。HIE未合并心肌损伤组患儿Vs和脑rSO2均低于对照组，差异有统计学意义（P〈0．05），但Vd和RI与对照组相比差异无统计学意义（P〉0．05）。（2）心动过缓患儿治疗后平均脑rSO2高于治疗前[（58．7±4．6）％与（50．9±3．2）％，f=6．239，P〈0．01]。结论缺氧性心肌Objective To investigate the effect of neonatal hypoxic myocardial injury and bradycardia on cerebral hemodynamies and brain tissue regional oxygen saturation （rSO2）, and to provide patho-physiological evidence for treatment of neonatal hypoxic ischemic encephalopathy （HIE） in acute phase. Methods Ninety-nine full-term newborns admitted into Department of Neonatology, Peking University First Hospital from December, 2005 to December,2008 were enrolled in this study. There were 18 newborns with both myocardial injury and HIE （group 1）, 31 newborns with HIE but without myocardial injury （group 2） and 50 cases of neonatal jaundice （control group）. From 3 to 7 days after birth, Doppler ultrasound was used to measure systolic velocity （Vs）, diastolic velocity （Vd） and resistance index （RI） of the anterior cerebral artery; and brain tissue rSO2 was detected by near-infrared spectroscopy. The differences among groups were compared by variance analysis and LSD test. Brain tissue rSOz before and after treatment of 20 newborns with bradycardia for various causes were detected and the difference was compared by paired t test. Results （1） Vs of group 1, group 2 and the control group was （19.35±5.13）, （29.35±4.28） and （32.62± 7.47） cm/s respectively; Vd was （6.43±2.98）, （11.21±3.16） and （11.50±3.03） cm/s; RI was0.68±0.10, 0.62±0.03 and 0.64±0.06; brain tissue rSO2 was （52.4±2.8）%, （54.6±3.1）%and （62.1±1.9）%. There were significant differences among the three group（F= 29. 999, 19. 393, 5. 283 and 137. 952, P〈0.01）. Vs, VdandrSO2 of group 1 were lower than that of group2 and the control group （P〈0.05）. RI of group 1 was higher than that of group 2 and the control group （P〈 0.05）. Vs and rSO2 of group 2 were lower than that of control group, but there were no differences between the two groups in Vd and RI. （2） The brain tissue rSOz of newborns with bradycardia after treatment was higher than that before treatment [（58.4±4

关 键 词：缺氧 心肌疾病 心动过缓 血流动力学 缺氧缺血 脑 氧 

分 类 号：R722.1[医药卫生—儿科]