东莨菪碱治疗新生儿缺氧缺血性脑病的研究

Studies on Mechanism and Effects of Scopolamine on Neonates with Hypoxic-ischemic Encephalopathy

目的 :探讨新生儿缺氧缺血性脑病 (HIE)的脑血流动力学变化及对东莨菪碱治疗HIE的作用机制及临床疗效。方法 :用超声多普勒仪测定 5 1例HIE和 48例非HIE患儿在出生后 3和 7d时的双侧大脑前动脉 (ACA)、大脑中动脉 (MCA)和大脑后动脉 (PCA)的血流动力学指标 ;测定 5 1例使用东莨菪碱的HIE患儿 (治疗组 )及 60例未使用东莨菪碱的HIE患儿 (非治疗组 )的各动脉血流动力学参数 ;跟踪观察并比较两组患儿行为神经测定 (NBNA)和智商 (IQ)。结果 :3d时HIE组脑血流速度较非HIE组普遍降低 ,以双侧ACA和左侧PCA的降低最为明显 ,7d时HIE组双侧ACA流速恢复 ,仅左侧PCA血流速度仍明显低于非HIE组 ;7d时治疗组中双侧ACA、MCA和PCA各血流参数均较非治疗组有明显改善 ;两组中、重度HIE患儿的NBNA和IQ差异均有显著性。结论 :HIE患儿的ACA、MCA、PCA血液流速普遍降低 ,以ACA和PCA最甚 ;东莨菪碱可明显地改善HIE患儿脑血流动力学 ,阻断脑细胞缺氧性损伤与脑血流动力异常之间的恶性循环 ,减轻缺氧性脑损伤 ,使脑功能在关键年龄段得到恢复。

Objective:To study the mechanism of HIE on neonates and the change of cerebral hemodynamics, and to explore the mechanism and effects of scopolamine in treating HIE. Method:Ultrasonography and doppler were used to determine the indices of hemodynamics of ACA?PCA and MCA by imaging 51 neonates with HIE and 48 cases of non HIE infants at the ages of 3rd day and 7th day after birth; to determine the parameters of hemodynamics by imaging 51 neonates with HIE who were given scopolamine and 60 neonates with HIE who were not. Results:At the age of 3 days, the cerebral blood flowing speed of HIE group was generally lower than that of non HIE group, and the most obvious reduction occurred in ACA on both sides( P <0.05) and PCA on the left( P <0.01). At the age of 7 days, the flowing speed of HIE group recovered, only the speed of left PCA was obviously lower that of than non HIE group. And the parameters of ACA, MCA, PCA in hemodynamics were improved more obviously than those of the non scopolamine group. According to the results of NBNA and IQ in scopolamine group, HIE recovered more quickly and earlier than the non scopolamnie group. Conclusion:The flowing speeds of HIE infants' ACA, MCA, PCA are generally lowered, which is inconsistent with the injury parts of HIE. Therefore, the change of cerebral hemodynamics of HIE infants is one of the pathological mechanisms in HIE. Scopolamine can obviously improve the cerebral hemodynamics of HIE infants, which means it can prevent cerebral ischemia injury and cerebral hemodynamics from viciously circling. Scopolamine favours the recovery of cerebral functions at the key age period.