新生儿缺氧缺血性脑病脑动脉血流动力学变化及对预后的影响
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摘要
目的探讨新生儿缺氧缺血性脑病脑动脉血流动力学变化及其预后评估价值。方法选取开封市妇产医院产科61例新生儿缺氧缺血性脑病(HIE)患儿作为研究组,其中轻度18例,中度26例,重度17例;并选取同期健康新生儿35例为对照组。检测、对比2组出生后24h、72h大脑前、中、后动脉血流动力学指标变化。结果出生后24h,与对照组相比,研究组大脑前、中、后动脉血流动力学指标平均流速、收缩期峰值流速、舒张期峰值流速均较低,阻力指数较高(P<0.05);出生后24h、72h,重度患儿阻力指数较中度患儿高,而中度患儿较轻度患儿高(P<0.05)。结论动态监测HIE患儿脑动脉血流动力学参数,可准确显示患儿脑部血流变化,指导临床早期诊治HIE,准确评估患儿病情及预后。
Objective To investigate the hemodynamic changes of cerebral artery in newborns with hypoxic-ischemic encephalopathy and evaluate value of the prognosis.Methods 61 newborns with hypoxic-ischemic encephalopathy in the department of obstetrics in Kaifeng Obstetrics and Gynecology Hospital were selected as the study group,of which 18 were mild,26 were moderate,and 17 were severe.Another 35 healthy newborns in the same period were selected as the control group.The changes in the hemodynamic indexes of the anterior,middle and posterior cerebral arteries of the two groups after birth of 24 hand 72 hwere detected and compared.Results Compared with the control group,the mean velocity,systolic peak velocity and diastolic peak flow velocity of the anterior,middle and posterior cerebral arteries in the study group after 24 hof birth were all lower,and the resistance index was relatively higher(P<0.05).After birth of 24 hand 72 h,the resistance index of severe children was higher than that of moderate children,and the moderate children were higher than those of mild children(P<0.05).Conclusion Dynamic monitoring of cerebral artery hemodynamic parameters in children with hypoxic-ischemic encephalopathy can accurately display changes of cerebral blood flow,guide early diagnosis and treatment of hypoxic-ischemic encephalopathy,and accurately assess the disease condition and prognosis of children.
Objective To investigate the hemodynamic changes of cerebral artery in newborns with hypoxic-ischemic encephalopathy and evaluate value of the prognosis.Methods 61 newborns with hypoxic-ischemic encephalopathy in the department of obstetrics in Kaifeng Obstetrics and Gynecology Hospital were selected as the study group,of which 18 were mild,26 were moderate,and 17 were severe.Another 35 healthy newborns in the same period were selected as the control group.The changes in the hemodynamic indexes of the anterior,middle and posterior cerebral arteries of the two groups after birth of 24 hand 72 hwere detected and compared.Results Compared with the control group,the mean velocity,systolic peak velocity and diastolic peak flow velocity of the anterior,middle and posterior cerebral arteries in the study group after 24 hof birth were all lower,and the resistance index was relatively higher(P<0.05).After birth of 24 hand 72 h,the resistance index of severe children was higher than that of moderate children,and the moderate children were higher than those of mild children(P<0.05).Conclusion Dynamic monitoring of cerebral artery hemodynamic parameters in children with hypoxic-ischemic encephalopathy can accurately display changes of cerebral blood flow,guide early diagnosis and treatment of hypoxic-ischemic encephalopathy,and accurately assess the disease condition and prognosis of children.
引文
[1]张金梅.早期护理干预对新生儿缺氧缺血性脑病预后的影响[J].现代中西医结合杂志,2014,12(23):2 611-2 613.
[2]邓莉,王章星,童燕梅,等.振幅整合脑电图对新生儿脑损伤的诊断及预后价值[J].湖北民族学院学报(医学版),2016,33(2):14-17.
[3]LAPTOOK A R,SHANKARAN S,TYSON J E,et al.Effect of Therapeutic Hypothermia Initiated After 6Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy:A Randomized Clinical Trial[J].JAMA,2017,318(16):1 550.
[4]曾玲.新生儿缺氧缺血性脑病发病及预后影响因素分析[J].新乡医学院学报,2017,34(4):313-315.
[5]张又红.脑血流改变对新生儿缺氧缺血性脑病脑损伤及预后的评价[J].中国中西医结合影像学杂志,2016,14(4):387-389.
[6]胡晓燕.缺氧缺血性脑病新生儿治疗前后血t-PA、PAI-1水平的变化[J].临床儿科杂志,2014,32(4):325.
[7]郭颖,秦桂秀.新生儿缺氧缺血性脑病血清低氧诱导因子1α与新生儿行为神经测定的相关性研究[J].中国药物与临床,2015,25(6):859-861.
[8]SRINIVASAKUMAR P,ZEMPEL J,TRIVEDI S,et al.Treating EEG Seizures in Hypoxic Ischemic Encephalopathy:A Randomized Controlled Trial[J].Pediatrics,2015,136(5):1 302-1 309.
[9]林思思.缺血缺氧脑病患儿血流动力学及血清脑钠肽神经生长因子变化研究[J].浙江临床医学,2017,19(7):1245-1 247.
[10]陈江红,王娜,黄乃磊.脐动脉和胎儿大脑中动脉血流频谱预测新生儿缺血缺氧性脑病的价值[J].广东医学,2017,38(11):1 707-1 710.
[11]刘世雷.新生儿缺氧缺血性脑病应用不同时间窗早期干预对预后的影响评价[J].河北医学,2014,20(5):802-804.
[12]刘婉趋,杨梅雨.振幅整合脑电图在新生儿缺氧缺血性脑病早期诊断及预后评估中的价值[J].中国生育健康杂志,2016,27(3):253-255.
[13]MALMQVIST J,OLSEN O.Reply to:Planned home birth and the association with neonatal hypoxic ischemic encephalopathy[J].J Perinat Med,2018,46(2):229-230.
[14]盛红玲,姜元培,王保刚,等.新生儿缺氧缺血性脑病血清TNF?α和IL-6动态变化及临床意义[J].国际检验医学杂志,2016,37(10):1 322-1 324.
[15]李金辉,王海申,李春红,等.彩色多普勒超声在新生儿缺氧缺血性脑病早期诊断中的临床应用[J].中国当代医药,2016,23(6):67-69.
[16]袁二伟,张雅静,曲海新,等.经颅彩色多普勒超声联合血清NSE在新生儿缺血缺氧性脑病早期诊断中的意义[J].现代生物医学进展,2016,16(36):7 147-7 150.
[17]鲁旭,姜泓,张渊韬.新生儿缺氧缺血性脑病发病机制研究进展[J].新乡医学院学报,2016,33(10):927-929.
[18]娄元俊,史华,单海军,等.盐酸纳洛酮联合丹参注射液治疗新生儿缺氧缺血性脑病的临床观察[J].中国药房,2016,27(23):3 264-3 266.
[19]陈立平,柏天军,庞善军,等.磁共振成像和磁共振波谱对新生儿缺氧缺血性脑病预后的早期诊断价值及预后评估[J].中国妇幼保健,2016,31(16):3 407-3 409.
[20]尚云,石计朋,杨卫红,等.肿瘤坏死因子α、超敏C反应蛋白在新生儿缺氧缺血性脑病中的变化及临床意义[J].安徽医药,2016,20(8):1 498-1 501.
[21]王月怡,沈文莉,高彩云,等.振幅整合脑电图在新生儿缺氧缺血性脑病早期诊治及预测预后中的应用价值[J].临床和实验医学杂志,2017,16(12):1 227-1 230.
[22]胡胜伟,陈勇华,陈清平,等.磁共振常规系列及DWI对新生儿缺氧缺血性脑病早期诊断及预后评估的价值探讨[J].基层医学论坛,2017,21(19):2 534-2 535.
[23]宋战义,李沁晏,廉荣镇,等.视频脑电图在新生儿缺氧缺血性脑病早期诊断及预后评估中的价值[J].现代电生理学杂志,2017,24(2):83-88.
[24]王娜,张遇乐,关步云.大脑中动脉中央支血流动力学评价新生儿缺血缺氧性脑病[J].南方医科大学学报,2014,34(8):1 199-1 202.
[25]张燕辉,黄嘉成,陈淑媛,等.HIE大脑中动脉血流动力学变化与血清S100B水平的相关性研究[J].中南医学科学杂志,2016,44(2):170-174.
[26]黄润英,蔡强,郑巍,等.缺血缺氧脑病患儿脑血流动力学及脐血BNP、NGF、NSE水平研究[J].海南医学,2017,28(20):3 325-3 327.
[27]孟卫霞,黄莉芬.缺氧缺血性脑病患儿血流动力学及血清神经生长因子、髓磷脂碱性蛋白、脑钠肽水平变化[J].中国临床医生杂志,2017,45(2):100-102.
[28]吴小洁,陈晓华,林水华,等.经颅彩超在新生儿缺氧缺血性脑病中的应用价值[J].上海医药,2016,37(23):62-65.
[29]李宏伟,弓瑜.经颅二维及彩色多普勒超声在新生儿缺血缺氧性脑病中的应用研究[J].中外医疗,2015,34(29):184-185.
[30]曲海新,郭卫平,袁二伟,等.新生儿缺氧缺血性脑病患儿的脑血流改变及其在预后评估中的临床价值[J].中国医药导报,2015,12(23):75-78.
[31]MASSARO A N,GOVINDAN R B,VEZINA G,et al.Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia[J].J Neurophysiol,2015,114(2):818-824.
[32]WANG N,ZHANG Y,GUAN B.Evaluation of neonatal hypoxic-ischemic encephalopathy by ultrasound measurement of thehemodynamics in the central branches of the middle cerebral artery[J].Nan Fang Yi Ke Da Xue Xue Bao,2014,34(8):1 199-1 202.
[33]包克珍,黄勇,胡晓泽,等.新生儿缺氧缺血性脑病危险因素及预后分析[J].中国妇幼保健,2016,31(5):971-973.
[34]HOWLETT J A,NORTHINGTON F J,GILMORE M M,et al.Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy[J].Pediatr Res,2013,74(5):525-535.
[35]ILVES P,LINTROP M,TALVIK I,et al.Changes in cerebral and visceral blood flow velocities in asphyxiated term neonates withhypoxic-ischemic encephalopathy[J].J Ultrasound Med,2009,28(11):1471-1 480.
[2]邓莉,王章星,童燕梅,等.振幅整合脑电图对新生儿脑损伤的诊断及预后价值[J].湖北民族学院学报(医学版),2016,33(2):14-17.
[3]LAPTOOK A R,SHANKARAN S,TYSON J E,et al.Effect of Therapeutic Hypothermia Initiated After 6Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy:A Randomized Clinical Trial[J].JAMA,2017,318(16):1 550.
[4]曾玲.新生儿缺氧缺血性脑病发病及预后影响因素分析[J].新乡医学院学报,2017,34(4):313-315.
[5]张又红.脑血流改变对新生儿缺氧缺血性脑病脑损伤及预后的评价[J].中国中西医结合影像学杂志,2016,14(4):387-389.
[6]胡晓燕.缺氧缺血性脑病新生儿治疗前后血t-PA、PAI-1水平的变化[J].临床儿科杂志,2014,32(4):325.
[7]郭颖,秦桂秀.新生儿缺氧缺血性脑病血清低氧诱导因子1α与新生儿行为神经测定的相关性研究[J].中国药物与临床,2015,25(6):859-861.
[8]SRINIVASAKUMAR P,ZEMPEL J,TRIVEDI S,et al.Treating EEG Seizures in Hypoxic Ischemic Encephalopathy:A Randomized Controlled Trial[J].Pediatrics,2015,136(5):1 302-1 309.
[9]林思思.缺血缺氧脑病患儿血流动力学及血清脑钠肽神经生长因子变化研究[J].浙江临床医学,2017,19(7):1245-1 247.
[10]陈江红,王娜,黄乃磊.脐动脉和胎儿大脑中动脉血流频谱预测新生儿缺血缺氧性脑病的价值[J].广东医学,2017,38(11):1 707-1 710.
[11]刘世雷.新生儿缺氧缺血性脑病应用不同时间窗早期干预对预后的影响评价[J].河北医学,2014,20(5):802-804.
[12]刘婉趋,杨梅雨.振幅整合脑电图在新生儿缺氧缺血性脑病早期诊断及预后评估中的价值[J].中国生育健康杂志,2016,27(3):253-255.
[13]MALMQVIST J,OLSEN O.Reply to:Planned home birth and the association with neonatal hypoxic ischemic encephalopathy[J].J Perinat Med,2018,46(2):229-230.
[14]盛红玲,姜元培,王保刚,等.新生儿缺氧缺血性脑病血清TNF?α和IL-6动态变化及临床意义[J].国际检验医学杂志,2016,37(10):1 322-1 324.
[15]李金辉,王海申,李春红,等.彩色多普勒超声在新生儿缺氧缺血性脑病早期诊断中的临床应用[J].中国当代医药,2016,23(6):67-69.
[16]袁二伟,张雅静,曲海新,等.经颅彩色多普勒超声联合血清NSE在新生儿缺血缺氧性脑病早期诊断中的意义[J].现代生物医学进展,2016,16(36):7 147-7 150.
[17]鲁旭,姜泓,张渊韬.新生儿缺氧缺血性脑病发病机制研究进展[J].新乡医学院学报,2016,33(10):927-929.
[18]娄元俊,史华,单海军,等.盐酸纳洛酮联合丹参注射液治疗新生儿缺氧缺血性脑病的临床观察[J].中国药房,2016,27(23):3 264-3 266.
[19]陈立平,柏天军,庞善军,等.磁共振成像和磁共振波谱对新生儿缺氧缺血性脑病预后的早期诊断价值及预后评估[J].中国妇幼保健,2016,31(16):3 407-3 409.
[20]尚云,石计朋,杨卫红,等.肿瘤坏死因子α、超敏C反应蛋白在新生儿缺氧缺血性脑病中的变化及临床意义[J].安徽医药,2016,20(8):1 498-1 501.
[21]王月怡,沈文莉,高彩云,等.振幅整合脑电图在新生儿缺氧缺血性脑病早期诊治及预测预后中的应用价值[J].临床和实验医学杂志,2017,16(12):1 227-1 230.
[22]胡胜伟,陈勇华,陈清平,等.磁共振常规系列及DWI对新生儿缺氧缺血性脑病早期诊断及预后评估的价值探讨[J].基层医学论坛,2017,21(19):2 534-2 535.
[23]宋战义,李沁晏,廉荣镇,等.视频脑电图在新生儿缺氧缺血性脑病早期诊断及预后评估中的价值[J].现代电生理学杂志,2017,24(2):83-88.
[24]王娜,张遇乐,关步云.大脑中动脉中央支血流动力学评价新生儿缺血缺氧性脑病[J].南方医科大学学报,2014,34(8):1 199-1 202.
[25]张燕辉,黄嘉成,陈淑媛,等.HIE大脑中动脉血流动力学变化与血清S100B水平的相关性研究[J].中南医学科学杂志,2016,44(2):170-174.
[26]黄润英,蔡强,郑巍,等.缺血缺氧脑病患儿脑血流动力学及脐血BNP、NGF、NSE水平研究[J].海南医学,2017,28(20):3 325-3 327.
[27]孟卫霞,黄莉芬.缺氧缺血性脑病患儿血流动力学及血清神经生长因子、髓磷脂碱性蛋白、脑钠肽水平变化[J].中国临床医生杂志,2017,45(2):100-102.
[28]吴小洁,陈晓华,林水华,等.经颅彩超在新生儿缺氧缺血性脑病中的应用价值[J].上海医药,2016,37(23):62-65.
[29]李宏伟,弓瑜.经颅二维及彩色多普勒超声在新生儿缺血缺氧性脑病中的应用研究[J].中外医疗,2015,34(29):184-185.
[30]曲海新,郭卫平,袁二伟,等.新生儿缺氧缺血性脑病患儿的脑血流改变及其在预后评估中的临床价值[J].中国医药导报,2015,12(23):75-78.
[31]MASSARO A N,GOVINDAN R B,VEZINA G,et al.Impaired cerebral autoregulation and brain injury in newborns with hypoxic-ischemic encephalopathy treated with hypothermia[J].J Neurophysiol,2015,114(2):818-824.
[32]WANG N,ZHANG Y,GUAN B.Evaluation of neonatal hypoxic-ischemic encephalopathy by ultrasound measurement of thehemodynamics in the central branches of the middle cerebral artery[J].Nan Fang Yi Ke Da Xue Xue Bao,2014,34(8):1 199-1 202.
[33]包克珍,黄勇,胡晓泽,等.新生儿缺氧缺血性脑病危险因素及预后分析[J].中国妇幼保健,2016,31(5):971-973.
[34]HOWLETT J A,NORTHINGTON F J,GILMORE M M,et al.Cerebrovascular autoregulation and neurologic injury in neonatal hypoxic-ischemic encephalopathy[J].Pediatr Res,2013,74(5):525-535.
[35]ILVES P,LINTROP M,TALVIK I,et al.Changes in cerebral and visceral blood flow velocities in asphyxiated term neonates withhypoxic-ischemic encephalopathy[J].J Ultrasound Med,2009,28(11):1471-1 480.