颅内出血新生儿的脑血流动力学变化

Hemodynamic changes of brain in newborns with intracranial hemorrhage

目的探讨颅内出血新生儿超声检查时的脑血流动力学变化。方法选择2010年12月1日至2012年6月30日于河南省安阳市妇幼保健院出生的61例通过新生儿早期超声影像学检查诊断的颅内出血新生儿作为病例组，根据超声检查结果对颅内出血的病情进行分级，并分为轻度和重度颅内出血组，分别为54例和7例。选择同期出生的50例健康新生儿作为对照组。采用多普勒超声仪对所有患儿大脑中动脉（middle cerebral artery，MCA）、大脑前动脉（anterior cerebral artery，ACA）颅内段的收缩期峰流速（peak systolic velocity，Vs）、舒张期末流速（end diastolic velocity，Vd）、平均流速（mean velocity，Vm）和阻力指数（resistance index，RI）等进行测定。统计学分析采用t检验。结果61例颅内出血患儿中，Ⅰ级12例（19．7％），Ⅱ级42例（68．9％），Ⅲ级6例（9．8％），Ⅳ级1例（1．6％）。轻度颅内出血组和重度颅内出血组MCA和ACA的Vs、Vm和Vd均显著低于对照组，差异均有统计学意义[MCA：（55．1±9．1）cm／s，（53．0±6．5）cm／s与（60．1±10．3）cm／s；（34．2±6．1）cm／s，（32．5±5．2）cm／s与（38．2±6．9）cm／s；（17．1±4．8）cm／s，（15．3±4．0）cm／s与（20．2±5．3）cm／s。ACA：（41．3±11．7）cm／s，（39．4±9．2）cm／s与（45．3±9．8）cm／s；（25．2±5．8）cm／s，（23．3±4．9）cm／s与（28．1±5．9）cm／s；（15．0±3．9）cm／s，（13．2±3．1）cm／s与（15．9±3．8）cm／s，P均〈0．05]；R1均显著高于对照组，差异均有统计学意义（MCA：0．70±0．10，0．77±0．07与0．62±0．10；ACA：0．67±0．06，0．73±0．08与0．61±0．05；P均〈0．05）。重度颅内出血组MCA和ACA的Vs、Vd和Vm均显著低于轻度出血组，RI显著高于轻度出血组，差异具有统计学意义（P均〈0．05）。结论新生儿合并颅内出血时，超声检查MCA和ACA颅内段的血流有明显变化，重度颅内出血时变化更明显。

Objective To explore the hemodynamic changes in the brains of newborns with intracranial hemorrhage. Methods Totally, 61 newborns, born in Anyang Maternal and Child Health Hospital of Henan Province, with intracranial hemorrhage diagnosed by ultrasound in early neonatal period, and 50 healthy newborns, also born in the same hospital from December 1, 2010 to June 30, 2012, were selected. Intracranial hemorrhage newborns were graded according to the severity of hemorrhage and divided into mild （n=45） and severe groups （n=7）. The peak systolic flow velocity （Vs）, end diastolic velocity （Vd）, mean flow velocity （Vm） and resistance index （RI） in the middle cerebral artery （MCA） and anterior cerebral artery （ACA） of brain were measured by Doppler ultrasound. T-test was applied for statistical analysis. Results Among the 61 neonates with intracranial hemorrhage, 12 （19.7%） were grade Ⅰ, 42 （68.9%） were grade Ⅱ, 6 （9.8%） were grade Ⅲ , and one （1.6%） was grade Ⅳ. The Vs, Vm and Vd of MCA and ACA in the mild and severe intracranial hemorrhage group were significantly lower than those in the control group, the differences were statistically significant [ MCA： （ 55. 1±9.1 ） cm/s, （ 53.0±6.5 ） cm/s vs （60.1 ± 10.3） cm/s;（34. 2±6.1） cm/s,（32.5±5.2） cm/s vs （38.2±6.9） cm/s; （17.1±4.8） cm/s, （15.3± 4.0） cm/svs （20.2±5.3） cm/s. ACA： （41. 3±11. 7） cm/s,（39.4±9.2） cm/svs （45.3±9.8） cm/s; （25.2±5.8） cm/s,（23. 3±4. 9） cm/s vs （28.1±5.9） cm/s;（15.0±3.9） cm/s,（13.2±3.1） cm/s vs （15.9±3.8） cm/s, all P〈0. 05]. But the RI values were significantly higher in the control group,the differences were statistically significant （MCA：0.70±0. 10,0.77±0.07 vs 0.62±0. 10;ACA： 0.67±0.06,0.73±0.08 vs0.61±0.05;allP〈0.05）. TheVs, VmandVdof MCAand ACAinthe severe intracranial hemorrhage group were significantly lower than in the mild hemorrhage group, while the RI values were significantly higher, and the differences were statistically significant （all P〈 0.05）. Conclusions Newborns with intracranial hemorrhage have significant hemodynamic changes in the brain and more prominent changes could be found in those with severe intracranial hemorrhage.