血流动力学显著型动脉导管未闭影响早产儿脑血流参数的病例系列报告

The effect of haemodynamically significant patent ductus arteriosus on cerebral blood flow parameters in premature infants:A case series report

背景早产儿易发生血流动力学显著的动脉导管未闭(hsPDA)进而引起脑血流参数的改变,且对于动脉导管结扎术后脑血流的恢复情况报道较少。目的通过床旁经颅多普勒超声测量脑血流参数,分析hsPDA对早产儿脑血流的影响以及动脉导管结扎术后脑血流的恢复情况。设计病例系列报告。方法检索浙江大学医学院附属儿童医院HIS系统中2022年7月至2023年1月NICU收治的诊断中含hsPDA且出生胎龄<37周的病例为病例组,以同期NICU中出生胎龄<37周并于出生72 h后经超声心动图检查证实无PDA的新生儿为参照人群。两组共同排除合并紫绀型或复杂型先天性心脏病、重度颅内出血或重度脑积水以及出现肠道感染坏死穿孔行手术治疗的病例。通过超声心动图测量大脑中动脉和基底动脉的血流参数。主要结局指标动脉导管结扎术后大脑中动脉和基底动脉的血流参数。结果病例组28例,经药物治疗(7例)和手术治疗(21例)后动脉导管均闭合,男14例(50%),PDA内径为(2.77±0.53)mm;参照人群30例,男性14例(46.7%),两组间性别、出生体重、超声检查日龄差异均无统计学意义,病例组出生胎龄小于参照人群,差异有统计学意义。大脑中动脉和基底动脉:收缩期峰值流速(Vs)病例组术前与参照人群差异无统计学意义,舒张末期流速(Vd)病例组术前低于参照人群、阻力指数(RI)和收缩期峰值流速与舒张末期流速比值(S/D)病例组术前高于参照人群,差异均有统计学意义;基于病例组术后(21例行动脉导管结扎术后72 h内)大脑中动脉和基底动脉脑血流参数(Vs、Vd、RI和S/D)与参照人群差异均无统计学意义。结论hsPDA引起早产儿大脑动脉前、后循环的血流参数异常;行动脉导管结扎术后脑血流可快速恢复。

Background Premature infants are prone to hemodynamically significant patent ductus arteriosus(hsPDA),which can lead to changes in cerebral blood flow parameters.However,there is limited research on the recovery of cerebral blood flow after ductus arteriosus ligation.ObjectiveTo analyze the impact of hsPDA on cerebral blood flow in premature infants and the recovery of cerebral blood flow after ductus arteriosus ligation using bedside transcranial Doppler ultrasound measurements.DesignCase series report.MethodsCases who were diagnosed with hsPDA,born at a gestational age of less than 37 weeks,and admitted to the NICU of Zhejiang University School of Medicine Children's Hospital from July 2022 to January 2023,were selected from the HIS system as the case group.The control group consisted of infants with gestational age<37 weeks at the same period in NICU who were confirmed to have no PDA by echocardiography after 72 hours of birth.Cases with concurrent cyanotic or complex congenital heart diseases,severe intracranial hemorrhage or hydrocephalus,and cases undergoing surgical treatment for intestinal infection,necrosis,and perforation were excluded from both groups.Cerebral blood flow parameters of the middle cerebral artery(MCA)and basilar artery(BA)were measured using echocardiography.Main outcome measuresBlood flow parameters of MCA and BA after ductus arteriosus ligation.ResultsThere were twenty-eight cases in the case group.Arterial duct closure was achieved through medical treatment in 7 cases and surgical intervention in 21 cases.Fourteen cases(50%)were male,and the internal diameter of the PDA was measured to be 2.77±0.53 mm.The control group consisted of 30 cases,and 14 cases(46.7%)were male.No statistically significant differences were found in gender,birth weight,and age between the two groups.The gestational age at birth in the case group was lower than that in the control group,and this difference was statistically significant.For the MCA and BA,the preoperative systolic peak flow velocity(Vs)between the case group and control group had no statistically significant differences;the end-diastolic velocity(Vd)in the case group were lower compared to that in the control group;the preoperative resistance index(RI)and the ratio of Vs to Vs(S/D)were both higher in the case group than that in the control group.These differences were statistically significant.The cerebral blood flow parameters(Vs,Vd,RI and S/D)of MCA and BA in case group after surgery(within 72 hours after PDA ligation surgery in 21 cases)have no statistically significant differences compared to that in the control group.ConclusionhsPDA causes the abnormities of blood flow parameters in the anterior and posterior circulation of cerebral artery in premature infants.After ductus arteriosus ligation,cerebral blood flow can rapidly recover.