摘要
目的探讨动脉导管未闭(PDA)早产儿生后早期脑血流动力学变化及其与脑损伤的关系。方法对2019年7月-2020年7月我院收治的75例胎龄≤34周的早产儿生后早期进行床旁超声心动图和颅脑超声检查,根据动脉导管闭合情况以及有无血流动力学改变进行分组,即血流动力学改变PDA组(hsPDA)30例,无血流动力学改变PDA组(nhsPDA)15例,无PDA组(nPDA)30例,分别记录各组早产儿生后24 h的大脑前动脉(ACA)和大脑中动脉(MCA)的收缩期峰流速(Vs)、舒张末期流速(Vd)、平均流速(Vm)、阻力指数(RI),并进行颅脑追踪检查,比较各组早产儿的脑损伤情况。结果hsPDA组的ACA、MCA的Vd值显著低于nhsPDA组(P=0.01,P=0.02)和nPDA组(P=0.002,P=0.001);而hsPDA组的ACA、MCA的RI值显著高于nhsPDA组(P=0.03,P=0.02)和nPDA组(P=0.003,P=0.002)。3组间的Vs、Vm比较,差异无统计学意义(均P>0.05)。hsPDA组共检测出脑损伤阳性14例,发生率46%;nhsPDA组和nPDA组各检出阳性例数为3例和5例,发生率分别为20%、17%;hsPDA组的脑损伤的发生率显著高于nhsPDA组、nPDA组,组间比较差异均有统计学意义(均P<0.05)。结论早产儿具有血流动力学改变的动脉导管未闭可造成脑血流动力学变化,从而增加脑损伤的发生率。
Objective To investigate the changes of cerebral hemodynamics in premature infants with patent ductus arteriosus(PDA)early after birth and its relationship with brain injury.Methods A total of 75 premature infants with gestational age≤34 weeks were examined by bedside echocardiography and cranial ultrasound in the early postnatal period.According to the status of arterial catheter closure and the presence or absence of hemodynamic changes,they were divided into hemodynamic significant PDA group(hsPDA)(30 cases),non-hemodynamic significant PDA group(nhsPDA)(15 cases)and non-PDA group(nPDA)(30 cases).Peak systolic velocity(Vs),end-diastolic velocity(Vd),mean velocity(Vm)and resistant index(RI)of anterior and middle cerebral artery(ACA and MCA)were monitored within 24 hours of birth,and follow up with cranial ultrasound in order to record incidence of brain injury in each group.Results Vd of ACA and MCA were lower in the hsPDA group than those in the nhsPDA group(P=0.01,P=0.02)and the nPDA group(P=0.002,P=0.001),while RI were higher than in the nhsPDA group(P=0.03,P=0.02)and the nPDA group(P=0.003,P=0.002).A total of 14 cases of brain injury were detected in the hsPDA group,with an incidence of 46%,3 cases of brain injury in the nhsPDA group and 5 cases of brain injury in the nPDA group were detected,with an incidence of 20%and 17%.The incidence of brain injury in the hsPDA group was higher than that in the other two groups,showing statistical significance(P<0.05).Conclusion Premature infants with hemodynamic changes of patent ductus arteriosus can cause changes in cerebral hemodynamics,thereby increasing the incidence of brain injury.
作者
罗平香
谢敏
詹春仙
杨斌
LUO Ping-xiang;XIE Min;ZHAN Chun-xian;YANG Bin(Department of Neonatology,Fujian Maternal and Child Health Care Hospital,Fuzhou City,Fujian Province,350001,China;Department of Ultrasound,Fujian Maternal and Child Health Care Hospital,Fuzhou City,Fujian Province,350001,China)
出处
《蛇志》
2021年第3期307-310,共4页
Journal of Snake
基金
福建省妇幼保健院青年科学基金项目(妇幼:YCXQ18-37)。
关键词
早产儿
动脉导管未闭
血流动力学
脑损伤
颅脑超声
Premature infant
Patent ductus arteriosus
Haemodynamics
Brain injury
Cerebral ultrasound
