颅脑超声对宫内窘迫新生儿脑损伤的早期诊断价值  

Early diagnostic value of cranial ultrasound for brain injury in neonates with intrauterine distress

作　　者：邱敬涛[1] 王晨雨[1] QIU Jingtao;WANG Chenyu(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2024年第3期307-310,共4页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划项目(编号:LHGJ2022492)。

摘　　要：目的探讨颅脑超声对宫内窘迫新生儿脑损伤的诊断价值。方法对146例宫内窘迫新生儿行颅脑超声及常规MRI检查,并将超声检查结果与MRI结果进行对比分析。根据脑损伤情况分为脑损伤组(n=46)和无脑损伤组(n=100),分析比较2组新生儿大脑中动脉和前动脉血流动力学指标[收缩期血流速度(PSV)、舒张末期血流速度(EDV)及阻力指数(RI)],采用受试者工作特征(ROC)曲线分析其对脑损伤的诊断价值。结果146例宫内窘迫新生儿中46例存在影像学异常征象,阳性检出率31.74%(46/146),其中MRI的检出率为91.30%(42/46),明显高于颅脑超声的65.22%(30/46,χ^(2)=9.200,P=0.002)。缺氧缺血性脑病(12.33%比5.48%,χ^(2)=4.222,P=0.040)、硬膜或蛛网膜下腔出血(2.74%比0,χ^(2)=4.056,P=0.044)的MRI检出率明显高于颅脑超声(P<0.05),脑室周围-脑室内出血的颅脑超声检出率明显高于MRI(11.64%比4.79%,χ^(2)=4.540,P=0.033)。脑损伤组新生儿大脑中动脉和前动脉PSV、EDV小于无脑损伤组,RI大于无脑损伤组(P<0.05)。ROC曲线显示,大脑中动脉和前动脉PSV、EDV和RI诊断脑损伤的曲线下面积分别为0.710、0.786、0.625和0.740、0.819、0.613。结论颅脑超声可早期发现宫内窘迫新生儿脑组织结构改变及血流动力学变化,在脑室周围-脑室内出血方面的检出率优于MRI,但脑损伤诊断效果不如MRI,临床可根据患儿情况选择合适检查方案。Objective To investigate the diagnostic value of cranial ultrasound for brain injury in neonates with intrauterine distress.Methods Totally 146 neonates with intrauterine distress were examined by cranial ultrasound and conventional MRI,and the results of ultrasound and MRI were compared and analyzed.According to the degree of brain injury,the neonates were divided into the brain injury group(n=46)and the non-brain injury group(n=100).The hemodynamic parameters(peak systolic velocity(PSV),end diastolic velocity(EDV)and resistance index(RI))of the middle cerebral artery and anterior artery were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze its diagnostic value in brain injury.Results Among 146 neonates with intrauterine distress,46 cases had abnormal imaging signs,and the positive detection rate was 31.74%(46/146).The detection rate of MRI was 91.30%(42/46),which was significantly higher than that of cranial ultrasound was 65.22%(30/46,χ^(2)=9.200,P=0.002).The detection rate of MRI in patients with hypoxic ischemic encephalopathy(12.33%vs 5.48%,χ^(2)=4.222,P=0.040)and dural or subarachnoid hemorrhage(2.74%vs 0,χ^(2)=4.056,P=0.044)was significantly higher than that of cranial ultrasound(P<0.05),while the detection rate of periventricular intraventricular hemorrhage by cranial ultrasound was significantly higher than that of MRI(11.64%vs 4.79%,χ^(2)=4.540,P=0.033).The PSV and EDV of the middle cerebral artery and anterior cerebral artery in the brain injury group were smaller than those in the non-brain injury group,while RI was larger than that in the non-brain injury group(P<0.05).ROC curve showed that the areas under the curve of PSV,EDV and RI in the middle and anterior cerebral arteries for diagnosing brain injury were 0.710,0.786,0.625,and 0.740,0.819,0.613,respectively.Conclusion Craniocerebral ultrasound can early detect the changes in brain tissue structure and hemodynamics in neonates with intrauterine distress,and the detection rate of periventricular-

关 键 词：宫内窘迫 新生儿 颅脑超声 脑损伤 磁共振 大脑中动脉 大脑前动脉 脑室周围-脑室内出血 

分 类 号：R651.15[医药卫生—外科学]