彩色多普勒超声在新生儿缺血缺氧脑病中的临床应用

Application of color Doppler ultrasound to early diagnosis of neonatal hypoxic-ischemic encephalopathy

目的:探讨彩色多普勒超声在新生儿缺氧缺血性脑病(HIE)早期诊断及预后评估中的应用价值。方法:采用二维超声、彩色多普勒超声检查技术床边检测67例经临床诊断HIE患儿(观察组)和24例正常足月儿(对照组)出生后24h内的脑实质回声改变,测量双侧大脑中动脉(middle cerebralartery,MCA)血流动力学,HIE患儿按照临床表现分为轻度、中度及重度3组,并对各组血流动力学变化进行比较。结果:二维超声显示观察组中67例患儿脑实质回声均有不同程度改变,基底节回声增强、结构模糊,脑室变窄或消失等表现;彩色多普勒显示患儿MCA血流动力学参数与对照组有明显变化。观察组MCA的血流参数与对照组比较,观察组MCA的PSV及EDV测值均增加,RI降低,差异有统计学意义(P<0.05);观察组中各组之间血流参数比较,差异有统计学意义(P<0.05)。结论:彩色多普勒超声能准确评价新生儿HIE脑血流动力学改变,在HIE的早期诊断及预后评估中有重要的临床意义。

Objective： To discuss the application of color Doppler ultrasound to the early diagnosis and prognosis evaluation of hypoxic-ischemic encephalopathy （HIE） in neonates. Methods： The echo changes of cerebral parenchymal on 67 neonates diagnosed with HIE （observation group） and 24 cases of normal neonates （control group） were clinically observed by 2-D ultrasonography and color Doppler ultrasound at bedside 24 hours after their birth,and the haemodynamics of the middle cerebral arterial （MCA） of the bilateral brain was measured. The HIE patients were divided into 3 groups： the mild,moderate and severe degree groups. And all the haemodynamics parameters were compared among the groups. Results. The 2-D ultrasonography results in the 67 patients showed the echo of cerebral parenchyma was maldistributed to some degrees,the enhencement of basal ganglion echo,illstructures,and the narrowed or disappeared ventricle; while the color Doppler ultrasonography results showed that there was obvious changes in the hemodynamics parameters of MCA between the neonatal patients in the observation group and the control group. The systolic peak velocity （PSV）, end diastolic velocity （EDV）,and resistant index （RI） of MCA were obviously higher than those of the control group,while RI of MCA was lower than that of the control group, which were of statistical differences （P〈0. 05）. Conclusion： Color Doppler ultrasonography can make an accurate evaluation of haemodynamics changes in HIE neonates,so it is important in early clinical diagnosis and prognosis of HIE.