妊娠期高血压疾病母体分娩的新生儿颅脑超声影像特征

Neonatal craniocerebral ultrasonographic features in pregnancy with maternal hypertensive disorder

目的分析妊娠期高血压疾病母体分娩的新生儿颅脑超声影像特征,探讨新生儿颅脑损伤的情况及脑血流动力学的改变。方法选取2015年10月至2017年8月北京潞河医院新生儿重症监护室收治的进行颅脑筛查的新生儿156例,妊娠期高血压疾病母体分娩的81例新生儿为研究组,75例无高危围产因素母体分娩的新生儿为对照组,分别进行颅脑超声影像学观察,分析2组新生儿围生期资料、颅脑损伤的情况及脑血流动力学的改变。结果研究组的新生儿平均出生体质量为(2769.62±657.76)g,显著低于对照组的(3423.1±521.8)g,差异有统计学意义(t=6.623,P <0.001)。研究组母体分娩孕周平均为(36.43±1.99)周,与对照组的(39.02±1.12)周比较,差异有统计学意义(Z=-7.311,P <0.01);研究组早产率为61.7%(50/81),与对照组的0(0/75)比较,差异有统计学意义(χ2=68.134,P <0.001)。研究组新生儿颅脑损伤的发生率、大脑前动脉(ACA)以及双侧大脑中动脉(MCA)的血流阻力指数(RI)值均显著高于对照组,差异有统计学意义(χ2=14.956,t=-5.798、-4.099、-3.943,P均<0.001)。新生儿血流动力学的改变与母体妊娠期高血压水平呈正相关(rACA、r左侧MCA、r右侧MCA=0.461、0.296、0.305,P均<0.001)。结论颅脑超声是新生儿颅脑异常首选和动态监测的方法,检测ACA及MCA血流RI值可以评估母体妊娠期高血压疾病对新生儿的影响,准确反映患儿脑部血流变化,为妊娠期高血压疾病母体分娩的新生儿临床早期诊治及干预提供依据。

Objective To analyze the characteristics of craniocerebral ultrasonographic images in neonates with maternal hypertensive disorder complicating pregnancy,and to discuss the changes of craniocerebral injury and cerebral hemodynamics.Methods From October2015to August2017,156newborns admitted by neonatal intensive care unit of Beijing Luhe Hospital were selected for craniocerebral screening.The study group included81cases of neonates with gestational hypertension,and75neonates with no high-risk perinatal factors were enrolled as the control group.Craniocerebral ultrasound imaging was performed to analyze the perinatal data,craniocerebral injury and cerebral hemodynamics in two groups of newborns.Results The neonatal mass of the study group was(2769.62±657.76)g,significantly lower than(3423.1±521.8)g of the control group(t=6.623,P<0.001).The maternal gestational weeks of the study group were(36.43±1.99)weeks,and the premature rate was61.7%(50/81),while in the control group they were(39.02±1.12)weeks and0%(0/75).The differences were statistically significant(Z=-7.311,P<0.01;χ^2=68.134,P<0.001).The results of ultrasound examination showed that the incidence of craniocerebral injury,the blood flow resistance index(RI)value of anterior cerebral artery(ACA)and bilateral middle cerebral artery(MCA)in the study group were significantly higher than those of the control group with statistically significant differences(χ^2=14.956,t=-5.798,-4.099,-3.943;all P<0.001).Neonatal craniocerebral injury and hemodynamic changes were positively correlated with maternal gestational hypertension(rACA,rleft MCA,rright MCA=0.461,0.296,0.305;all P<0.001).Conclusions Craniocerebral ultrasonography is the first choice in dynamic monitoring of neonatal craniocerebral abnormalities.The RI values of ACA and MCA can be used to evaluate the influence of hypertensive disease in pregnancy on newborn,and can accurately reflect the changes of blood flow in the neonatal brain,which provide the basis for the early diagnosis and treatment of neonates with hypertensive diseases during pregnancy.