新生儿缺氧缺血性脑病脑血流改变的临床研究

Clinical study on cerebral hemodynamics in neonatal hypoxic ischemic encephalopathy

目的探讨新生儿缺氧缺血性脑病（HIE）患儿脑血流动力学变化,为临床上早期诊断HIE和判定预后提供理论依据。方法随机选择HIE患儿39例和健康新生儿20例为研究对象,各组均在入院后每24 h采用经颅多普勒超声（TCD）检测1次大脑中动脉（MCA）脑血流动力学参数,包括收缩期峰值速度（Vs）、舒张末期速度（Vd）及阻力指数（RI）。结果TCD显示生后24 h内HIE组脑血流速度Vs、Vd均低于对照组,24 h后逐渐上升;RI均明显升高,中重度组RI在72-96 h迅速下降。结论TCD显示HIE患儿生后24 h内脑血流阻力增加,血流速度减慢,48-96 h脑血流阻力降低,血流速度逐渐恢复。

Objective It is to approach the change of cerebral hemodynamics in neonatal hypoxic ischemic encephalopathy（HIE）,hope to offer theoretical proof for the early period diagnosis and judging prognosis.Methods 39 cases of newborn infants with HIE were randomly divided into three groups.There were 12 cases in mild group,15 cases in moderate group and 12 cases in severe group respectively.20 healthy newborns were served as control group.The cerebral hemodynamics data of middle cerebral artery（MCA） included systole period peak velocity（Vs）,end diastolic velocity（Vd） and resistance index（RI） in all the cases were detected with transcranial Doppler ultrasound（TCD） every 24 h.Results During 24 h after birth,TCD showed that the cerebral arteries blood velocity（Vs and Vd） in HIE groups were all lower than that in control group,and the data raised gradually 24 h later.Meanwhile,RI increased in HIE groups,but it was lowered expeditiously in moderate and severe groups in 72-96 h.Conclusion TCD shows that the cerebral blood flow resistance increased,and the cerebral blood flow velocity decreased during 24 h after birth.In 48-96 h after birth,the cerebral blood flow resistance lowered and the cerebral blood flow velocity recovers gradually.