血压变异性联合脑血流参数在预测极低出生体重早产儿脑室内出血的作用

The role of blood pressure variability indicators combined with cerebral blood flow parameters in predict⁃ing intraventricular hemorrhage in very low birth weight preterm infants

目的评价血压变异性(BPV)、大脑前动脉(ACA)血流参数在胎龄≤32周、出生体质量≤1500 g早产儿脑室内出血(IVH)中的预测价值。方法选择新生儿重症监护室(NICU)收治的胎龄≤32周、出生体质量≤1500 g的早产儿为研究对象。所有早产儿生后1 h内入院,每间隔1 h监测收缩压(SBP)、舒张压(DBP)和平均动脉压(MABP),采用最大值与最小值之差(max-min)、标准差(SD)、变异系数(CV)、连续变异系数(SV)作为BPV指标,入院第1、3、7天行头颅彩超检查,筛查IVH的发生,第1天同时测量ACA的收缩期峰流速率(Vs)、舒张末期血流速度(Vd)和阻力指数(RI)。依据头颅彩超检查结果将早产儿分为IVH组和非IVH组,分析BPV指标、ACA血流参数与IVH发生的关系。结果共92例早产儿符合纳入标准,其中IVH组49例,非IVH组43例。两组早产儿的胎龄、出生体重、性别、围产期病史等基线特征差异无统计学意义(P>0.05)。SBP SD(OR=1.480,95%CI:1.020~2.147)和ACA-RI(OR=3.027,95%CI:2.769~3.591)是早产儿发生IVH的独立危险因素,联合检测SBP SD和ACA-RI预测IVH的敏感度为61.2%,特异度为79.1%。结论高BPV和ACA-RI与胎龄≤32周、出生体重≤1500 g早产儿IVH发生相关,联合SBP SD、SBP CV和ACA-RI检测对于IVH的早期识别有一定的预测作用。

Objective Hemodynamic instability is the main factor in the development of intraventricular hemorrhage(IVH)in preterm infants.The purpose of this study is to evaluate the predictive value of blood pressure variability(BPV)and anterior cerebral artery(ACA)blood flow parameters in IVH in preterm infants with gesta⁃tional age≤32 weeks and birth weight≤1500 g.Methods Preterm infants with gestational age≤32 weeks and birth weight≤1500 g admitted to the neonatal intensive care unit(NICU)were selected as the research subjects.All preterm infants were admitted within 1 hour after birth,and systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial blood pressure(MABP)were monitored every 1 hour interval.The difference between maximum and minimum values(max⁃min),standard deviation(SD),coefficient of variation(CV),and successive variation(SV)were used as BPV indicators.On the 1st,3rd,and 7th day of admission,transcranial ultrasound examination was performed to screen for the occurrence of IVH.On the 1st day,systolic velocity(Vs),diastolic velocity(Vd),and resistance index(RI)of ACA were measured simultaneously.Preterm infants were divided into IVH group and non IVH group based on the results of transcranial ultrasound examination,and the correlation between BPV indicators,ACA blood flow parameters,and the development of IVH was analyzed.Results A total of 92 preterm infants met the inclusion criteria,including 49 in the IVH group and 43 in the non IVH group.There was no statistically significant difference in baseline characteristics such as gestational age,birth weight,gender,and perinatal medical history between the two groups of preterm infants(P>0.05).SBP SD(OR=1.48095%CI:1.020~2.147),and ACA⁃RI(OR=3.02795%CI:2.769~3.591)are independent risk factors for IVH in preterm infants.The sensitivity and specificity of combined detection of SBP SD,and ACA⁃RI in predicting IVH were 61.2%and 79.1%,respectively.Conclusion High BPV and ACA⁃RI are related to IVH in preterm infants with gestational age≤32 weeks and birth weight≤1500 g.Combined detection of SBP SD,and ACA⁃RI has a certain predictive ef⁃fect on early identification of IVH.