摘要
目的 应用经颅彩色多普勒超声(TCD)检测缺氧缺血性脑病(HIE)新生儿大脑中动脉(MCA)血流参数变化,分析其与病情严重程度及预后的相关性。方法 选取我院新生儿重症监护病房收治的75例HIE新生儿,根据其病情严重程度分为轻度组38例、中度组24例、重度组13例,另选同期健康新生儿75例为对照组。分别于出生48 h及72 h后行TCD检查,测量并比较各组MCA血流参数[收缩期血流速度峰值(Vs)、舒张末期血流速度(Vd)、平均流速(Vm)、阻力指数(RI)]的差异。对HIE新生儿随访28 d,复查TCD并采用新生儿神经行为测定(NBNA)量表评估其预后,比较预后良好者与预后不良者MCA血流参数的差异。采用Pearson相关分析法分析HIE新生儿MCA血流参数与NBNA评分的相关性。结果 出生48 h后,对照组、轻度组、中度组、重度组Vs、Vd、Vm均依次降低,RI均依次增高,两两比较差异均有统计学意义(均P<0.05)。出生72 h后,对照组、中度组、重度组Vs、Vd、Vm均依次降低,RI均依次增高,两两比较差异均有统计学意义(均P<0.05);轻度组各参数与中、重度组比较差异均有统计学意义(均P<0.05),与对照组比较差异均无统计学意义。75例HIE新生儿中,预后不良者23例,平均NBNA评分为(29.47±2.53)分;预后良好者52例,平均NBNA评分为(37.42±1.15)分,二者比较差异有统计学意义(P<0.05)。预后不良者出生48 h、72 h及28 d后Vs、Vd、Vm均低于预后良好者,RI高于预后良好者,差异均有统计学意义(均P<0.001)。相关性分析显示,HIE新生儿出生48 h、72 h及28 d后Vs、Vd、Vm与NBNA评分均呈正相关(均P<0.05),RI与NBNA评分均呈负相关(均P<0.05)。结论 随着病情程度的加重,HIE新生儿MCA血流参数中Vs、Vd、Vm呈降低趋势,RI呈增高趋势;应用TCD监测脑血流动力学参数可较为客观地反映HIE新生儿脑血流灌注变化情况,对其预后预测有一定的指导意义。
Objective To observe the changes of blood flow parameters of middle cerebral artery(MCA)in neonates with hypoxic-ischemic encephalopathy(HIE)by transcranial Doppler sonography(TCD),and to analyze their correlation with disease severity and prognosis.Methods A total of 75 neonates with HIE admitted to neonatal intensive care unit in our hospital were enrolled and divided into mild group(38 cases),moderate group(24 cases)and severe group(13 cases)according to disease severity.A total of 75 healthy neonates during the same period were enrolled as control group.TCD examinations were performed at 48 h and 72 h after birth.The differences in MCA blood flow parameters[peak systolic velocity(Vs),end-diastolic velocity(Vd),mean velocity(Vm),resistance index(RI)]were compared among groups.Neonates with HIE were followed up for 28 d,the TCD reexamination and prognosis assessment by neonatal behavioral neurological assessment(NBNA)were performed.The differences in MCA blood flow parameters between good prognosis and poor prognosis were compared.The correlation between MCA blood flow parameters and NBNA score in HIE neonates was analyzed by Pearson correlation analysis.Results At 48 h after birth,Vs,Vd,Vm were gradually decreased in control group,mild group,moderate group and severe group,while RI was gradually increased,and the differences between any two groups were statistically significant(all P<0.05).At 72 h after birth,Vs,Vd and Vm were gradually decreased in control group,moderate group and severe group,while RI was gradually increased,and the differences between any two groups were statistically significant(all P<0.05).At 72 h after birth,there were significant difference in MCA blood flow parameter between mild group and moderate group,severe group(all P<0.05).Among the 75 neonates with HIE,23 cases with poor prognosis[average NBNA score was(29.47±2.53)points]and 52 cases with good prognosis[average NBNA score was(37.42±1.15)points],and there was significant differences between the two kinds of neonates(P<0.05).At 48 h,72 h and 28 d after birth,Vs,Vd and Vm in neonates with poor prognosis were lower than those with good prognosis,while RI was higher than that with good prognosis,and the differences were statistically significant(all P<0.001).Correlation analysis showed that at 48 h,72 h and 28 d after birth,Vs,Vd and Vm were positively correlated with NBNA score(all P<0.05),while RI was negatively correlated with NBNA score(all P<0.05).Conclusion With the aggravation of disease,the MCA blood flow parameters Vs,Vd and Vm decrease,while RI increases in HIE neonates.The monitoring of TCD cerebral hemodynamics parameters can objectively reflect the changes of cerebral blood perfusion,which has certain guidance significance for prognosis prediction.
作者
马利亚
冯景
付杰
李晓雪
MA Liya;FENG Jing;FU Jie;LI Xiaoxue(Department of Ultrasound,the People’s Hospital of Bozhou,Anhui 236800,China)
出处
《临床超声医学杂志》
CSCD
2024年第1期75-79,共5页
Journal of Clinical Ultrasound in Medicine
基金
安徽医科大学校科研基金项目(2022xkj231)。
关键词
超声检查
颅脑
缺氧缺血性脑病
新生儿
病情严重程度
预后
Ultrasonography,craniocerebral
Hypoxic-ischemic encephalopathy
Neonates
Disease severity
Prognosis
