新生儿缺氧缺血性脑病患儿的脑血流改变及其在预后评估中的临床价值  

Changes of cerebral blood flow in neonates with hypoxic ischemic encephalopathy and the clinical value of prognostic evaluation of prognosis

作　　者：曲海新[1] 郭卫平[1] 袁二伟[1] 张雅静[1] 许津莉[1] 

机构地区：[1]河北北方学院附属第一医院小儿内科,河北张家口075000

出　　处：《中国医药导报》2015年第23期75-78,共4页China Medical Herald

基　　金：河北省医学科学研究重点课题项目(20090590)

摘　　要：目的探讨新生儿缺氧缺血性脑病（HIE）的脑血流改变及在预后评估中的应用价值。方法选择2012年1月-2014年12月河北北方学院附属第一医院产科出生的足月新生儿54例为研究对象（观察组）,所有患儿均有窒息史,同时选取我院产科同期出生的30例健康新生儿为对照组,检测并比较两组新生儿出生后24、48、72、120 h大脑前动脉（ACA）、大脑中动脉MCA）、大脑后动脉（PCA）的阻力指数（RI）、舒张期流速（Vd）、收缩期峰值流速（Vs）时间以及平均流速（Vm）;观察两组新生儿脑动脉血流动力学变化情况。结果与对照组比较,观察组新生儿出生后24、48 h时ACA、MCA及PCA的Vd、Vs、Vm均明显降低（P〈0.05）,同时RI显著增高（P〈0.05）;新生儿出生后72、120 h时上述各项指标与对照组比较,差异均无统计学意义（P〉0.05）。新生儿生后24、48、72、120 h,轻、中、重度HIE患儿RI比较,差异均有统计学意义（P〈0.05）,且随着HIE严重程度增加,RI不断升高,差异有统计学意义（P〈0.05）。结论采用彩色多普勒超声动态监测HIE患儿的脑动脉血流动力学参数,能准确地反映患儿脑部血流变化,在HIE的早期诊断、病情判断及预后评估中具有重要意义。Objective To investigate the changes of cerebral blood flow in neonates with hypoxic ischemic encephalopathy（HIE） and its application value in evaluation of prognosis. Methods 54 full-term newborns who enrolled from January 2012 to December 2014 in Obstetrical Department of the First Affiliated Hospital of Hebei North University（＂our hospital＂ for short） were selected as the study objects（observation group）, all newborns had history of asphyxia; and 30 health newborns born at the same time in Obstetrical Department of our hospital were selected as control group. 24, 48, 72 and 120 h after birth, the RI, Vd, Vs, Vm of ACA, MCA, PCA in two groups were detected and compared; and the changes of cerebral artery hemodynamics were observed. Results Compared with control group, the Vd,Vs, Vm of ACA, MCA and PCA in observation group 24, 48 h after birth were decreased（P〈0.05）, and RI were increased（P〈0.05）; differences between two group 72, 120 h after birth in the above parameters were not statistically significant（P〉0.05）. RI of newborns with mild, moderate, severe HIE, in different time points were significantly different（P〈0.05）, with the increase of the of HIE severity, RI was increased, the difference was statistically significant（P〈0.05）. Conclusion Cerebral artery hemodynamic parameters by using color Doppler ultrasound to dynamic monitoring neonatal hypoxic ischemic encephalopathy, can accurately reflects the changes in blood flow to brain, has important significance in early diagnosis, assessment of severity and prognosis of HIE.

关 键 词：新生儿缺氧缺血性脑病 脑血流改变 评估 

分 类 号：R722.12[医药卫生—儿科]