摘要
目的探讨床旁颅脑超声检查对围生期窒息患儿早期脑组织结构及血流动力学改变的诊断价值。方法选取南通市第一人民医院于2015年1月至2016年1月期间收治或接生的72例有围生期窒息病史的新生儿,在患儿出生后72h内,对其行首次颅脑超声检查,大脑中动脉、前动脉血流动力学变化采用多普勒技术监测,阻力指数(RI)、收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)为检测的主要参数。结果新生儿出生后72h内行首次颅脑超声检测的72例患儿中表现颅脑损伤阳性率达75.0%(54/75)。患儿脑血流动力学发生改变20例,其中10例Vd增加,RI减少(≤0.55);6例Vd、Vs均减少,RI正常;频谱高尖3例,且RI增加(≥8.00);仅有1例患儿大脑一侧中动脉Vd、Vs增加,RI正常。早产儿脑组织损伤类型中最多见的两种为脑白质损伤12例(46.2%),χ~2=11.466,P=0.001,颅内出血16例(61.5%),χ~2=4.043,P=0.044;足月儿脑组织损伤类型中最多见的两种为脑水肿15例(32.6%),χ~2=1.852,P=0.396,颅内出血17例(37.0%),χ~2=4.135,P=0.026;早产儿颅内出血率、脑白质损伤率均高于足月儿,足月儿的脑水肿发生率高于早产儿(χ~2值分别为4.043、11.466、5.437,均P<0.05)。两组患儿的丘脑基底核损伤率、血流动力学改变率之间差异无统计学意义(χ~2值分别为0.573、0.015,均P>0.05)。结论缺氧缺血性颅脑损伤在围生期窒息患儿中常见,患儿早期脑组织结构及血流动力学的改变可被颅脑超声发现,其检查时间在72h内阳性率较高,对于新生儿重症监护室(NICU)的患儿而言,床旁检查是超声的优势。
Objective To investigate the diagnostic value of bedside cranial ultrasound examination on structure and hemodynamic changes of brain tissue in early stage of perinatal asphyxia. Methods Altogether 72 neonates with perinatal asphyxia history delivered or hospitalized in First People＇s Hospital of Nantong from January 2015 to January 2016 were selected,and they underwent first cranial ultrasound examination at 72 h after birth. Hemodynamic changes of middle cerebral artery and anterior cerebral artery were monitored by Doppler technique,and resistance index（ RI）,peak systolic velocity（ Vs） and end diastolic velocity（ Vd） were main detection parameters.Results Positive rate of brain injury of 72 patients undergoing first cranial ultrasound examination within 72 h after birth reached 75. 0%（ 54/72）. Twenty patients had cerebral hemodynamic changes,including 10 cases with Vd increase and RI decrease（ ≤0. 55）,6 cases with decreased Vd and Vs and normal RI,3 cases with high spectrum and increased RI（ ≥8. 00）,and only 1 case with increased brain artery Vd and Vs and normal RI. The most common types of brain injury in preterm infants were cerebral white matter damage occurring in12 cases（ 46. 2%）（ χ2= 11. 466,P = 0. 001） and intracranial hemorrhage in 16 cases（ 61. 5%）（ χ2= 4. 043,P = 0. 044）. The most common types of brain injury in full-term infants were cerebral edema occurring in 15 cases（ 32. 6%）（ χ2= 1. 852,P = 0. 396） and intracranial hemorrhage in 17 cases（ 37. 0%）（ χ2= 4. 135,P = 0. 026）. Incidences of intracranial hemorrhage and white matter injury in preterm infants were both higher than in full-term infants,and the incidence of cerebral edema in full-term infants was higher than in preterm infants（ χ2value was 4. 043,11. 466 and 5. 437,respectively,all P 〈0. 05）. The differences in basal ganglia injury incidence and hemodynamic change of cases between two groups were not statistically significant（ χ2value was 0. 573 and 0. 015,respect
出处
《中国妇幼健康研究》
2017年第3期276-278,共3页
Chinese Journal of Woman and Child Health Research
关键词
围生期
窒息
血流动力学
超声
Perinatal period
asphyxia
hemodynamics
ultrasonic
