大脑中动脉多普勒超声血流动力学参数在早产儿预后评估中的应用价值

Application value of middle cerebral artery hemodynamic parameters in prognostic evaluation of premature infants

目的应用彩色多普勒超声检测大脑中动脉(MCA)血流动力学变化,探讨其在评估早产儿预后中的临床价值。方法选取我院早产儿174例,根据出生后6个月的0~6岁小儿神经心理发育评估结果中的发育商分为预后不良组102例(发育商<85分)和预后良好组72例(发育商≥85分),应用超声检测并比较两组早产儿MCA收缩期峰值流速(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)及阻力指数(RI);分析MCA血流动力学参数预测早产儿预后不良的诊断效能。结果预后不良组早产儿PSV、EDV低于预后良好组,PI、RI高于预后良好组,两组比较差异均有统计学意义(均P<0.05);PSV、EDV、RI与早产儿不良预后相关(列联相关系数=0.28、0.29、0.24),其评估预后不良的敏感性分别为26.47%、32.35%、52.94%,特异性分别为95.83%、93.06%、72.22%,准确率分别为55.17%、57.47%、60.92%。结论应用彩色多普勒超声检测早产儿MCA血流动力学参数对评估早产儿预后具有一定的临床价值。

Objective To investigate the clinical value of the hemodynamic changes of middle cerebral artery(MCA)detected by color Doppler ultrasound in predicting the prognosis of premature infants.Methods A total of 174 cases of premature infants in our hospital were divided into two groups according to the developmental quotient in the neuropsychological development assessment results of 0~6 years old infants born 6 months after birth:102 cases with the developmental quotient<85(poor prognosis group)and 72 cases with the developmental quotient≥85(good prognosis group).Peak systolic velocity(PSV),end diastolic velocity(EDV),pulsatility index(PI)and resistance index(RI)of MCA were measured by ultrasound.The receiver operating characteristic curve was drawn to analyze the diagnostic efficacy of MCA blood flow parameters in predicting poor prognosis of premature infants.Results PSV and EDV in poor prognosis group were lower than those in good prognosis group,and PI and RI were higher than those in good prognosis group(all P<0.05).PSV,EDV and RI were correlated with the poor prognosis of premature infants(the contingency coefficients were 0.28,0.29,0.24).The sensitivity of PSV,EDV and RI were 26.47%,32.35%,52.94%,and the specificity were 95.83%,93.06%,72.22%,the accuracy of PSV,EDV and RI were 55.17%,57.47%,60.92%,respectively.Conclusion The measurment of the blood flow parameters of MCA in premature infants by color Doppler ultrasound shows a certain clinical value in predicting the prognosis of premature infants.