早产儿早期低血压及血流动力学监测

Hypotension and hemodynamic monitoring in premature infants at early postnatal stage

新生儿出生后面临从胎儿循环到成人循环的过渡期,其血流动力学变化复杂。早产儿(尤其是极低/超低出生体重儿)心血管系统发育不成熟,生后早期血压不稳定,易合并低血压,可导致各脏器血流灌注不足、脑损伤,严重者甚至死亡。然而,低血压并不等同于低灌注,临床医生不能仅凭血压值进行干预,需结合血流动力学情况。目前国际上对早产儿低血压的定义和干预阈值尚未达成共识。该文对早产儿早期低血压的定义及血流动力学监测的研究现状作一简要综述,以期为临床诊疗提供参考。

Neonates are undergoing the transition period from fetal circulation to adult circulation,and the hemodynamic changes are complex.For premature infants(especially very low birth weight infants and extremely low birth weight infants),the cardiovascular systems are immature.Therefore,they are prone to hypotension at early postnatal stage.Hypotension may lead to multiple organ perfusion insufficience,cerebral lesion,and even death.However,it is not always accompanied by hypoperfusion.Before treatment,clinicians should evaluate the hemodynamics comprehensively.At present,there is no consensus on the definition and intervention threshold about hypotension in premature infants.This review summarizes the definitions and hemodynamic monitoring methods of hypotension in premature infants at early postnatal stage to provide references for diagnosis and treatments.