颅内出血早产儿生后四天内脑血流变化及围生因素分析

Changes in cerebral hemodynamics in the first 4 days after birth and perinatal factors analysis in the preterm infants with intracranial hemorrhage

目的 探讨颅内出血早产儿生后 4d内脑血流动力学的变化及颅内出血与围生因素的关系。方法 应用经颅多谱勒超声 (TCD)检测 2 9例颅内出血早产儿脑血流速度、阻力指数的变化及脑血流速度与平均动脉血压的关系 ,分析临床围生相关因素 ,并与同期无颅内出血的 2 8例早产儿进行比较。结果 颅内出血组早产儿于生后 2 4、4 8、72h脑血流速度增快 ,出生 2 4h平均脑血流速度与平均动脉血压相关 ,且与出生窒息、胎龄、出生体重、高PaCO2 有关。结论 颅内出血早产儿于生后 2 4h内存在脑血流自主调节功能破坏 ,生后 3d脑血流存在过度灌注 ;且出生窒息 ;胎龄 <32周、出生体重 <15 0 0 g及PaCO2 >6 6 7kPa为颅内出血的高危因素。

Objective To explore the changes in cerebral hemodynamics in the first 4 days after birth in premature infants with intracranial hemorrhage,and the correlation of intracranial hemorrhage with perinatal factors.Methods We studied cerebral blood flow velocities and resistance index in 29 premature infants with intracranial hemorrhage and 28 premature infants with normal brain by transcranial Doppler ultrasound,and the correlation of cerebral blood flow velocities with mean arterial blood pressure,and analyze clinical perinatal factors.Results Cerebral blood flow velocities in premature infants with intracranial hemorrhage at the age of 24,48, 72 h,The mean cerebral blood flow velocity and mean arterial blood pressure at the age of 24 h.The probability of intracranial hermorrhage is correlative. The probability of intracranial hemorrhage is comparatively high in premature infants with the following characteristics:birth asphyxia,gestational age less than 32 weeks,birth weight less than 1*!500 g and PaCO2>6.67 kPa.Conclusion There are impaired cerebrovascular autoregulation within 24 hours after birth and hyperperfusion in the first 3 days in premature infants with intracranial hemorrhage,and the following are the highly dangerous factors for intracranial hemorrhage:birth asphyxia,gestational age<32 weeks,birth weight<1*!500g and PaCO2>6.67*!kPa.