尼莫地平对缺氧缺血性脑病患儿脑血流动力学及脑实质密度的影响

Influence of nimodipine on cerebral hemodynamics indices and brain parenchyma density in neonates with hypoxic-ischemic encepbalopathy

目的探讨缺氧缺血性脑病（HIE）患儿脑血流动力学和脑实质密度改变及尼莫地平的干预作用。方法将58例中、重度HIE随机分成常规组28例，尼莫地平组30例，20例正常新生儿为对照组，尼莫地平组在常规治疗基础上给予尼莫地平，连用10～14d。HIE患儿于治疗前及治疗10～14d后用多普勒超声仪检测脑血流动力学。并于生后第3—5天及第10—14天行CT检查。结果①HIE患儿PSFV、EDFV及Vm低于对照组（P〈0．01）；RI高于对照组（P〈0．05）。治疗10—14d后，尼奠地平组PSFV、EDFV及Vm较常规组明显增高（P〈0．01），尼莫地平组RI元统计学意义，尼莫地平组大脑中动脉血流速度明显改善；②尼莫地平组在额叶皮质处CT值变化有统计学意义（P〈0．01）。结论HIE患儿脑血流动力学出现明显紊乱，检测脑血流动力学有助于HIE早期诊断和预后判断，并指导治疗；尼莫地平具有改善HIE患儿脑血液循环的作用，减轻脑损伤，且额叶皮质处脑实质密度恢复明显，提示尼莫地平对缺氧缺血性脑损伤具有保护作用。

Objective To explore the changes of cerebral hemodynamics indices and brain parenchyma density in neonates with hypoxic-ischemic encephalopathy （HIE） and the role of intervention with nimodipine. Methods 58 neonates with moderate and severe HIE were randomly divided into two groups including routine （ n = 28） and nimodipine （ n = 30）, with 20 healthy full-term neonates as controls. Based on the routine treatment, nimodipine was given intravenously in the nimodipine group for 10 - 14 days. The hemodynamics indices included peak systolic flow velocity （ PSFV ） , end-diastolic flow velocity （ EDFV ） , mean blood flow velocity （Vm） and resistance index（RI） of middle cerebral artery were detected by color Doppler ultrasound before and after treatment for 10 - 14 days respectively. After birth for 3 - 5 days and 10 - 14 days, neonates with HIE were examined by imaging examinations. Results ①PSFV, EDFV and Vm of HIE patients were significantly lower than those in control group（ P 〈 0. 01 ）. RI of HIE patients were significantly higher than those in control group（ P 〈 0. 05 ）. After treatment for 10 - 14 days, PSFV, EDFV and Vm were obviously elevated in nimodipine group than routine group（ P 〈 0. 01 ）. RI weren＇ t significantly differences in nimodipine group and routine group. The blood flow velocity of middle cerebral artery in nimodipine group got improvement than that in routine group, there was a significant differences between two groups （P 〈 0. 01 ）. ②After treatment for10 - 14 days, the computed tomography values were significant differences in nimodipine group than routine group in cortexes of frontal lobe（ P 〈 0. 01 ）. Conclusion The cerebral hemodynamics in neonates with HIE is disorder apparently. It may be helpful to evaluate the early diagnosis and prognosis of HIE and guide the clinical therapy of HIE using color Doppler ultrasound to monitor the hemodynamics indices. Nimodipine is effective in promoting and improving cerebral circulation and alleviate brain injury in neonates with HIE, the density of the brain parenchyma in neonates with HIE were significant recovery in cortexes of frontal lobe, indicating that nimodipine has a protective effect on hypoxic-ischemic damage in the neonate.