新生儿急性胆红素脑病脑血流动力学变化及其临床意义  

Changes of cerebral hemodynamics in neonatal acute billirubin encephalopathy and the clinical significance

作　　者：关函洲[1] 张新华[1] 王成虎[1] 王秋平[2] 樊迎朝[1] 郭健[1] GUAN Hanzhou;ZHANG Xinhua;WANG Chenghu;WANG Qiuping;FAN Yingzhao;GUO Jian(Department of Neonatal Internal Medicine,Children's Hospital of Shanxi,Shanxi,Taiyuan 030013,China;Color Doppler Ultrasound Room,Children's Hospital of Shanxi,Shanxi,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院新生儿内科,山西太原030013 [2]山西省儿童医院彩超室,山西太原030013

出　　处：《中国医药科学》2020年第14期5-8,35,共5页China Medicine And Pharmacy

基　　金：山西省儿童医院科研课题(201827)。

摘　　要：目的 探讨新生儿急性胆红素脑病脑血流动力学变化的临床意义,为新生儿急性胆红素脑病的发病机制、治疗及预后提供依据.方法 选取山西省儿童医院新生儿内科2016年6月-2019年6月收治的57例新生儿急性胆红素脑病患儿作为观察组,选取同期住院的咽下综合征、胃扭转且无黄疸的20例新生儿作为对照组.观察组治疗前及治疗后、对照组日龄7d内均采用多普勒超声检测左侧大脑中动脉的收缩期峰流速(PSV)、舒张末期流速(EDV)、阻力指数(RI),并化验血总胆红素水平.记录观察组治疗前后及对照组的血清总胆红素水平及脑血流动力学变化,分析胆红素水平与脑血流参数的关系,比较不同程度新生儿急性胆红素脑病患儿血清总胆红素水平及脑血流动力学参数.结果 观察组治疗前、治疗第3天、治疗第5-7天的血清总胆红素、PSV、EDV均明显高于对照组,差异有统计学意义(P<0.05);观察组治疗前、治疗第3天的RI明显低于对照组,差异有统计学意义(P<0.05);观察组治疗第5-7天的RI与对照组比较,差异无统计学意义(P>0.05).观察组治疗第3天、治疗第5-7天的血清总胆红素、PSV、EDV均明显低于治疗前,RI明显高于治疗前,差异有统计学意义(P<0.05).观察组治疗第3天的血清总胆红素、PSV均明显高于治疗第5-7天,RI明显低于治疗第5-7天,差异有统计学意义(P<0.05);观察组治疗第3天的EDV与治疗第5-7天比较,差异无统计学意义(P>0.05).随着病情转归,急性胆红素脑病患儿PSV、EDV显著下降,RI显著上升.所有患儿在治疗5-7d后各指标恢复至正常水平.重度组的胆红素峰值、EDV、PSV显著高于轻度、中度组,而RI则显著低于中度、轻度组,差异有统计学意义(P<0.05);中度组的胆红素峰值、EDV、PSV显著高于轻度组,而RI则显著低于轻度组,差异有统计学意义(P<0.05).Pearson相关因素分析显示,血胆红素水平与PSV、EDV呈正相关,与RI�Objective To explore the elinical signifcance of changes of cerebral hemody namics in neonatal acute bilirubin encephalopathy(ABE),and to provide basis for the pathogenesis,treatment and prognosis of neonatal ABE.Methods 57 neonates with neonatal ABE admitted to the Department of Neonatal Internal Medicine of Children's Hospital of Shanxi from June 2016 to June 2019 were selected as the observation group,and 20 neonates with swallowing syndrome,gastric volvulus(CV)and no jaundice hospitalized in the same period were selected as the control group.Doppler ultrasound was used to deteet peak systolie velocity(PSV),end-diastolie velocity(EDV),resistance index(RI)of the left middle cerebral artery(LMCA)and blood total bilirubin level was tested before and after treatment in the observation group and within 7 days after treatment in the control group.The changes of serum total bilirubin level and cerebral hemodynamics before and after treatment in the observation group and in the control group were recorded.The relationship between bilirubin level and cerebral blood flow parameters was analyzed.The serum total bilirubin level and cerebral hemodynamic parameters of infants with different degrees of neonatal ABE were compared.Results The serum total bilrubin,PSV,EDV of the observation group before treatment,on the 3rd d of treatment,and on the 5th to 7th d of treatment were all significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The RI before treatment and on the 3rd d of treatment in the observation group was signifcantly lower than that in the control group,and the difference was statistically significant(P<0.05).There was no saistially significant difference in RI between the observation group and the control group on the 5th to 7th d of treatment(P>0.05).The serum total bilirubin,PSV,EDV in the observation group on the 3rd d of treatment and on the 5th to 7th d of treatment were significantly lower than those before treatment,RI was significantly higher than th

关 键 词：婴儿 新生 脑 血流动力学 核黄疸 

分 类 号：R722.1[医药卫生—儿科]