近红外光谱仪监测窒息新生儿听觉刺激诱发时的脑氧合代谢及脑血流变化

Changes of cerebral blood flow and cerebral oxidative metabolism in asphyxia newborn during brain auditory activation.

目的了解窒息新生儿在听觉刺激诱发脑神经活动时的脑氧合代谢和脑血流量的改变.方法 1998～2003年北京中日友好医院儿科选择窒息新生儿34例为窒息组,健康新生儿40名为对照组.使用近红外光谱仪,观察听觉刺激试验诱发的脑氧合血红蛋白[Hb O2]、还原血红蛋白[Hb H]和总血红蛋白[Hb tot]浓度的变化,并比较两组脑氧合代谢和脑血流量的改变.根据[Hb O2]、[Hb H]和[Hb tot]不同的变化,将氧合代谢曲线分为A([Hb O2]、[Hb H]和[Hb tot]均增加); B([Hb O2]和[Hb tot]增加, [Hb H]降低);C([Hb O2]和[Hb tot]降低, [Hb H]增加)3种曲线类型.结果窒息组中25例(25/34、73.5%)显示C型变化,对照组中28例(28/40、70.0%)显示A型变化,两组中A、C两型例数比较差异显著(P<0.05).两组[Hb O2]和[Hb tot]数值变化幅度比较差异显著(P<0.05).结论窒息新生儿听觉刺激诱发相应皮层的神经活动时,显示局部脑血流量下降、氧合代谢降低,重度窒息儿更明显.

Objective To study the changes of cerebral oxidative metabolism and cerebral blood flow in newborns of asphyxia during brain auditory activation. Methods 34 cases of asphyxiated newborn as asphyxia group：mild asphyxia 18 cases, severe asphyxia 16 cases ,compared with 40 cases of health newborn as normal group. Using near-lnfrared spectroscopy （ NIRS） to monitor the concentration changes of [ Hb O2 ]. [ Hb H ]. [ Hb tot ] and to idendify the changes of cerebral oxidative metabolism and cerebral blood flow. According to the different changes of [ Hb O2 ], [ Hb H] and [ Hb tot] during auditory stimulation,the curves were classified into pattern A （[ Hb O2 ], [ Hb H ] and [ Hb tot ] increase）, B （ [ Hb O2 ], [ Hb tot ] increase, [ Hb H ] decrease ） and C （ [ Hb O2 ], [ Hb tot ] decrease, [ Hb H ] increase ）. Results Among asphyxia group,25 cases （ 25/34,73.5% ） showed pattern C. Among normal group,28 cases （ 28/40,70% ） showed pattern A. Comparing the number of cases of A and C between two groups,differences were significant, P 〈 0. 05. Comparing the rang of changes in [ Hb O2 ] and [ Hb tot] between two groups,differences were significant too, P 〈0. 05. Conclusion During brain auditory activation in asphyxiated newborns ,cerebral oxidative metabolism and cerebral blood flow all decrease, especially in the severe asphyxiated newborns.