颅内血管血流动力学检查在新生儿室管膜下出血的应用价值  

Application value of intracranial vascular hemodynamics in neonatal subependymal hemorrhage

作　　者：宁浩杰[1] 韦德湛[1] 陈洁莹[1] 吴雪丽[1] 张凤 成宇璐[1] 谢宏基 Ning Haojie;Wei Dezhan;Chen Jieying;Wu Xueli;Zhang Feng;Cheng Yulu;Xie Hongji(B Ultrasonic Room,Foshan Maternal and Child Health Care Hospital,Foshan 528000,China)

机构地区：[1]广东省佛山市妇幼保健院B超室,528000

出　　处：《中国医师杂志》2020年第1期59-62,共4页Journal of Chinese Physician

基　　金：佛山市卫生健康局医学科研基金项目(20170121)。

摘　　要：目的探讨室管膜下出血(SEH)的相关影响因素及脑血流动力学改变。方法收集2012年10月至2017年10月本院新生儿科收治的经颅脑超声诊断为室管膜下出血的早产新生患儿200例为观察组,以及同期其他疾病(非颅脑疾病及严重疾病)收住新生儿科的早产新生儿150例为对照组,分析室管膜下出血的独立危险因素,比较两组患儿收缩期最大血流速度(SV)、舒张期最大血流速度(DV)、收缩期与舒张期血流速度比值(S/D)、阻力指数(RI)、搏动指数(PI)水平差异。结果新生儿窒息、酸中毒、新生儿呼吸窘迫综合征(NRDS)、动脉导管未闭、凝血功能异常为室管膜下出血的独立危险因素;观察组患儿出血侧SV、DV高于对照组,差异有统计学意义(P<0.001);观察组患儿中出血侧SV、DV高于健侧,差异有统计学意义(P<0.001);110例单侧室管膜下出血者,出血吸收后,出血侧SV、DV、S/D、RI、PI与健侧比较差异无统计学意义(P>0.05)。结论室管膜下出血的患儿可以通过颅脑超声动态观察其ACA的血流动力学指标,通过评价其收缩期和舒张期血流速度,判断治疗效果,进而防止室管膜下出血进一步加重,给临床提供更多诊断和治疗依据。Objective To explore the related factors of subependymal hemorrhage(SEH)and cerebral hemodynamic changes.Methods From October 2012 to October 2017,200 cases of children with subependymal hemorrhage diagnosed by ultrasound in our department of pediatrics were selected as the observation group,and a total of 150 children who were admitted to the Department of Pediatrics in the same period due to craniocerebral diseases and other serious diseases were selected as control group.The independent risk factors of the children in the observation group were analyzed,and the difference of the maximum systolic blood flow velocity(SV),the diastolic maximum flow velocity(DV),the systolic and diastolic velocity ratio(S/D),the resistance index(RI),and the pulsatile index(PI)were compared between the two groups.Results Neonatal asphyxia,preterm birth,acidosis,neonatal respiratory distress syndrome(NRDS),patent ductus arteriosus and coagulation dysfunction were independent risk factors for subependymal hemorrhage.The bleeding side SV and DV of the observation group were higher than those of the control group,with statistically significant difference(P<0.001).In the observation group,the bleeding side SV and DV were higher than those of the healthy side,with statistically significant difference(P<0.001).There was no significant difference in bleeding side SV,DV,S/D,RI and PI in 110 cases of single side ependymal hemorrhage(P>0.05).Conclusions Children with ependymal hemorrhage can observe the hemodynamic indexes of anterior cerebral artery(ACA)dynamically by craniocerebral ultrasound,and judge the therapeutic effect by evaluating the systolic and diastolic blood flow velocity,so as to prevent the further aggravation of subependymal hemorrhage.

关 键 词：婴儿 早产 室管膜下出血 血流动力学 超声检查 多普勒 经颅 

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]