床旁颅脑超声对早产儿早期脑血流灌注特点的评价

Study on characteristics of early cerebral blood flow perfusion in premature infants by bedside craniocerebral ultrasound

目的:探讨早产儿早期大脑中动脉、豆纹动脉脑血流灌注特点,分析脑血流变化规律。方法 :选择80例早产儿为研究对象,按出生体质量分为A组(≥1 500 g)和B组(<1 500 g)各40例,另选择40例足月新生儿为足月儿组,分别于出生72 h内测量大脑中动脉、豆纹动脉血流动力学参数。结果:早产儿组大脑中动脉的收缩期峰值流速(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)明显低于足月新生儿组,且B组Vs、Vm均低于A组(均P<0.05);收缩期峰值流速与舒张末期速度比值(S/D)、RI组间差异无统计学意义(P> 0.05)。早产儿组豆纹动脉的Vs、Vd、Vm、S/D、RI均明显低于足月儿组,B组豆纹动脉的Vs、Vd、Vm均低于A组(均P<0.05)。结论:大脑中动脉、豆纹动脉的脑血流动力学变化可敏感反映脑血流的灌注状态,对评估脑损伤程度和判断预后有重要的临床价值。

Objective:To investigate the characteristics of cerebral blood flow perfusion in early middle cerebral artery and lenticulostriate arteries in premature infants,and to analyze the changes of cerebral blood flow. Methods:A total of 80 premature infants admitted to the premature ward of our hospital were included in the study. According to the birth weight,the premature infants were divided into group A (≥1 500 g,40 cases) and premature infant group B(<1 500 g,40 cases). The 40 fullterm neonates admitted to the neonatal ward at the same time were the full-term infants. The hemodynamic parameters of the middle cerebral artery and the lenticulostriate arteries were measured within 72 hours after birth. Results:Comparison of measurement parameters of middle cerebral artery:the peak systolic velocity(Vs),end-diastolic velocity(Vd),and mean blood flow velocity(Vm) of the middle cerebral artery in the premature infant group were significantly lower than those in the full-term neonate group. The Vs and Vm of the group were lower than those of the premature infant group A(P<0.05). There was no significant difference between the S/D and PI groups(P> 0.05). The comparison of the measured parameters of the lenticulostriate arteries:the lenticulostriate arteries of the premature infant group Vs,Vd,and Vm were significantly lower than those in the term infant group. S/D and RI were higher than those in the term infant group. The Vs,Vd,and Vm of the premature infant B group were lower than those of the preterm infant group A. The difference was statistically significant(P<0.05). Conclusions:The cerebral hemodynamic changes of middle cerebral artery and lenticulostriate arteries can sensitively reflect the perfusion state of cerebral blood flow,and have important clinical value for assessing the degree of brain injury and judging the prognosis.