摘要
目的探究脐动脉/大脑中动脉血流动力学参数比值在缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)患儿中的预测价值。方法回顾性分析74例出生前疑似有宫内窘迫、出生后确诊为HIE患儿的研究资料,设为观察组;并选取同期健康孕妇及新生儿63例设为对照组,2组胎儿产前1周及产前3 d均接受多普勒超声检查脐动脉与大脑中动脉,比较2组胎儿脐动脉、大脑中动脉参数[搏动指数(PI)、阻力指数(RI)]及脐动脉与大脑中动脉参数比值差异,分析脐动脉/大脑中动脉比值对新生儿HIE的预测价值。结果2组内产前3 d与产前1周时胎儿脐动脉、大脑中动脉的PI、RI及PI_(脐动脉/大脑中动脉)、RI_(脐动脉/大脑中动脉)值比较,差异无统计学意义(P>0.05);观察组脐动脉PI、RI、PI_(脐动脉/大脑中动脉)、RI_(脐动脉/大脑中动脉)均高于各时段对照组,大脑中动脉PI、RI低于各时段对照组,差异有统计学意义(P<0.05);产前1周时PI_(脐动脉/大脑中动脉)、RI_(脐动脉/大脑中动脉)及产前3 d时PI_(脐动脉/大脑中动脉)、RI_(脐动脉/大脑中动脉)预测新生儿是否患有HIE的曲线下面积(AUC)分别为0.800、0.725、0.840、0.846,截断值分别为1.249、1.327、1.315、1.403。结论新生儿是否患有HIE可表现为脐动脉/大脑中动脉血流动力学参数比值的改变,能为早期确立诊疗策略提供参考,具有较高临床检测价值。
Objective To explore the predictive value of umbilical artery/middle cerebral artery hemodynamic parameter ratio in children with hypoxic-ischemic encephalopathy(HIE).Methods The clinical data of 74 cases suspected of having intrauterine distress before birth and diagnosed with HIE after birth were retrospectively analyzed and were set as the observation group,and 63 healthy pregnant women and newborns during the same period were selected as the control group.All cases in the two groups received Doppler ultrasonography to examine the umbilical artery and middle cerebral artery 1 week before delivery and 3 days before delivery.The parameters of fetal umbilical artery,middle cerebral artery parameters[pulsatility index(PI),resistance index(RI)]and the ratio of umbilical artery to middle cerebral artery were compared between the two groups,and the predictive value of umbilical artery/middle cerebral artery ratio in neonatal HIE was analyzed.Results There was no significant difference in the values of PI,RI,PI(umbilical/middle cerebral artery)and RI(umbilical artery/middle cerebral artery)between the two groups at 3 days before delivery and 1 week before delivery(P>0.05).The values of umbilical artery PI,RI,PI(umbilical artery/middle cerebral artery)and RI(umbilical artery/middle cerebral artery)in the observation group were higher than those in the control group at each time period,while the values of PI and RI in the middle cerebral artery were lower than those in the control group at each time period,and the differences were statistical significance(P<0.05).The AUC of PI(umbilical artery/middle cerebral artery)and RI(umbilical artery/middle cerebral artery)for predicting whether neonates have HIE at one week before delivery and 3 days before delivery were 0.800,0.725,0.840,and 0.846,respectively,and the cutoff values were 1.249,1.327,1.315,and 1.403,respectively.Conclusion Whether a newborn has HIE can be expressed as an indicator of the ratio of umbilical artery/middle cerebral artery hemodynamic parameters,which
作者
董晓春
王洁静
刘涛
DONG Xiaochun;WANG Jiejing;LIU Tao(Department of Ultrasound, Puyang Oilfield General Hospital, Puyang Henan 457000, China)
关键词
缺氧缺血性脑病
脐动脉
大脑中动脉
血流动力学参数比值
hypoxic-ischemic encephalopathy
umbilical artery
middle cerebral artery
hemodynamic parameter ratio
