血流动力学改变对动脉导管未闭早产儿脑白质损伤发生的影响

Effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus

目的：探讨血流动力学改变对动脉导管未闭（PDA）早产儿脑白质损伤发生的影响。方法：具有血流动力学改变的PDA早产儿35例（hsPDA组）、没有血流动力学改变的PDA早产儿35例（非hsPDA组）、非PDA早产儿36例（对照组）分别于出生后3d、7d、14d检测血清神经特异性烯醇化酶（NSE）的水平，同时进行颅脑超声显像检查，作超声心动图显像PDA血流速度与颅脑超声显像侧脑室灰度值相关性分析。结果：出生后3d、7d、14d颅脑超声显像侧脑室灰度值hsPDA组均高于对照组（均P〈0．01），非hsPDA组与对照组差异均无统计学意义（均P〉0．05）；出生后3d、7d、14d血清NSE水平hsPDA组均高于对照组（均P〈0．01），非hsPDA组与对照组差异均无统计学意义（均P〉0．05）。早产儿PDA血流速度大小与超声显像侧脑室灰度值呈正相关（r=0．876，P〈0．01）。结论：hsPDA早产儿容易发生脑白质损伤，需要及时干预。

Objective：To investigate the effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus （PDA）. Methods：A total of 106 premature infants were enrolled in the study, including 35 PDA infants with hemodynamic changes （hsPDA group ）, 35 PDA infants without hemodynamie changes （non-hsPDA group） and 36 non-PDA infants （control group）. Serum level of neuron-specific enolase （NES） was detected and craniocerebral ultrasound examination was performed on d3, d7 and d14 after birth. The correlation between blood flow rate of PDA and gray scale value of lateral ventricle was analyzed. Results：Gray scale values of lateral ventricle and serum levels of NES in hsPDA group were higher than those in control group on d3, d7 and d14 （ P 〈 0. 01 ）, but no significant difference was observed between non-hsPDA group and control group （P 〉 0. 05）. There was a positive correlation between the blood flow rate of PDA and gray scale value of lateral ventricle （r = 0. 876, P 〈 0.01 ） in premature infants. Conclusion：Patent ductus arteriosus with hemodynamic changes is closely related to white matter damage in premature infants, and early intervention is necessary.