经颅二维及多普勒超声在新生儿缺血缺氧性脑病中应用研究

Application of transcranial two-dimensional and Doppler in diagnosis of neonatal hypoxic-ischemic encephalopathy

目的探讨二维及多普勒超声技术在新生儿缺血缺氧性脑病(HIE)诊疗中的临床应用价值。方法 34例临床诊断为HIE患儿(试验组),其中男性20例,女性14例;胎龄39～41周,平均胎龄39.2周(标准差1.3周);出生平均体质量3150g(标准差54 g)。应用SonoScape S8超声诊断仪测定HIE足月新生儿大脑中动脉各项血流参数[收缩期血流速度(Vs)、舒张期血流速度(Vd);平均血流速度(Vm)、阻力指数(RI)],分别于出生后24h及72h内检查,并与40例正常足月儿(对照组)的大脑中动脉血流参数进行对照分析。结果试验组患儿24h内20例表现为脑室周围白质回声异常增强,72h内所有患儿均出现双侧脑半球回声弥漫性增强。试验组患儿24h大脑中动脉Vs升高,Vd降低,72h Vs与Vd均升高,与对照组比较差异有统计学意义(P<0.05);大脑中动脉RI于24h内较对照组升高(P<0.05),而72h内降低(P<0.05)。结论超声影像能够动态观察HIE患儿颅内二维形态、回声改变及脑血流灌注的动态情况,早期诊断脑水肿,为临床诊疗提供有价值的依据。

Objective To evaluate the application of transcranial two-dimensional and color Doppler in neonatal hypoxic-ischemic encephalopathy（HIE） patients.Methods Thirty-four full term new born infants doubted with HIE were enrolled,male 20,female 14;gestational aged 39-41 weeks,mean gestational aged 39.2 weeks（± 1.3 weeks）,average birth weight was 3 150 g（± 54 g） which examined by SonoScape S8 ultrasonographic system within 24-hour and 72-hour post-natal.The blood flow parameters of middle cerebral artery included systolic velocity（Vs）,diastolic velocity（Vd）,mean flow velocity（Vm） and resistant index（RI） were measured and analyzed by transcranial two-dimensional color Dopper.Forty healthy newborn infants were enrolled as control group.Results The 20 of 34 HIE newborn infants showed per ventricular hyperecho within 24-hour.All cases presented diffused hyper echo in bilateral hemisphere post-asphyxia within 72-hour.Compared with the control group,Vs of HIE newborn infants increased significantly while Vd decreased within 24-hour（P 0.05）;Both Vs and Vd increased significantly within 72-hour.The RI increased within 24-hour but decreased within 72-hour.Conclusion It is demonstrated that transcranial ultrasonography may provide valuable information of echoic change and hemodynamic parameter of cerebral blood flow for HIE patients,and make early stage diagnosis for encephalon-edema.