经颅多普勒超声与CT平扫对新生儿缺氧缺血性脑病的诊断及临床分级研究

Diagnosis and Clinical Classification of Transcranial Doppler Sonography and CT Plain Scan for Neonatal Hypoxic Ischemic Encephalopathy

目的旨在探讨经颅多普勒超声(TCD)与CT平扫对新生儿缺氧缺血性脑病(HIE)的诊断及临床分评定价值。方法将2016年5月至2018年5月于我院新生儿病房68例HIE窒息新生儿的临床病例及随访资料进行回顾性分析,根据资料可知所有新生儿均行TCD和CT平扫检查,总结TCD和CT平扫对HIE的诊断符合率,并整理分析不同级别HIE患者超声血流、以及超声、CT平扫检查中相关影像图像特征。结果与轻度HIE组患儿比较,中、重度HIE组患儿其大脑中动脉Vd、Vs、Vm均明显降低,而PI和RI均明显较高;在大脑前动脉中Vs较轻度升高,而Vd、Vm、PI和RI均明显较轻度HIE明显升高(P<0.05);TCD对HIE的诊断符合率显著高于CT平扫者(χ~2=5.423,P=0.020);TCD检查中轻度HIE在超过侧脑室三角范围均为弥漫性增强高回声区,较脉络丛低;中度HIE为侧脑室周围不均匀回声,回声强度类似于脉络丛;在重度HIE中,脑实质弥漫性回声增强,较脉络丛高。CT平扫检查示轻度HIE可在脑叶处见斑片状低密度灶;中度HIE可在脑叶处呈现花瓣状和斑片状病灶,脑部灰、白质分界不清晰,且可合并颅内出血征象;而重度HIE在CT平扫中主要呈现弥漫性低密度灶于脑实质内,脑部灰、白质分界消失,可见反转征和(或)颅内出血,且在脑白质内显现多个密度灶点。结论较CT平扫而言,TCD对HIE的诊断符合率显著提高,且对于新生儿脑血流的动态观察更为清楚,更有利于评估患儿HIE分级和病情程度,进一步指导临床治疗而改善患儿预后情况。

Objective To determine the diagnosis and clinical classification of transcranial doppler sonography(TCD)and CT plain scan for neonatal hypoxic ischemic encephalopathy(HIE).Methods The clinical cases and follow-up data of 68 asphyxia neonates with HIE in the neonatal ward of our hospital from May 2016 to May 2018 were retrospectively analyzed.According to the data,all neonates underwent TCD and CT scans,and the diagnostic coincidence rate of TCD and CT plain scan for HIE was summed.The ultrasound blood flow of different levels of HIE patients and the characteristics of related images in ultrasound and CT plain scan were analyzed.Results Compared with those in children with mild HIE,Vd,Vs,and Vm of the middle cerebral artery were significantly lower in the moderate and severe HIE group,while PI and RI were significantly higher.In the anterior cerebral artery,Vs increased slightly,while Vd,Vm,PI and RI were significantly higher than those in neonates with mild HIE(P<0.05).The diagnostic coincidence rate of TCD for HIE was significantly higher than that of CT plain scan(χ~2=5.423,P=0.020).Mild HIE in the TCD examination showed diffusely enhanced hyperechoic region beyond the triangle of lateral ventricle,and the echo was lower than the choroid plexus.Moderate HIE showed an uneven echo around the lateral ventricle,and the echo intensity is similar to that of the choroid plexus.In severe HIE,the diffuse echo of the brain parenchyma is enhanced,which is higher than that of choroid plexus.CT plain scan showed mild HIE can be seen with patchy and low density lesions in the brain lobe.Moderate HIE can present petal-like and patchy lesions in the brain lobe.The boundary between gray matter and white matter of the brain was not clear,and the signs of intracranial hemorrhage can be combined.In CT plain scan,severe HIE mainly presents diffuse low-density lesions in the brain parenchyma,the boundary between gray matter and white matter of the brain disappeared,the reversal sign and/or intracranial hemorrhage were observed,and multiple density points appear in the white matter of the brain.Conclusion Compared with CT plain scan,the diagnostic coincidence rate of TCD for HIE is significantly higher,and the dynamic observation for neonatal cerebral blood flow is more clear,which is more favorable to assess the HIE classification and severity of the disease,and further guide clinical treatment to improve the prognosis of the child.