新生儿缺氧缺血性脑病的脑超声血流动力学特征及与临床预后的关系

目的探讨新生儿缺氧缺血性脑病(HIE)的经颅彩色多普勒超声(TCD)脑血流动力学变化特征及与临床预后的关系。方法选取HIE新生儿136例作为HIE组,同期健康新生儿100例作为对照组(NC组)。采用TCD测定大脑中动脉(MCA)的舒张期流速(Vd)、收缩期峰值血流速度(Vs)、平均血流速度(Vm)和阻力指数(RI);出生后28 d复查TCD,并进行中国20项新生儿行为神经测定(NBNA)评分。结果HIE组新生儿在出生24、48 h时,脑血流速度显著减慢,阻力指数显著升高,MCA的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组(P<0.05);出生后72 h,轻度HIE组血流动力学参数与NC组差异无统计学意义(P>0.05),中、重度HIE组的Vs、Vd、Vm均显著低于NC组,RI均显著高于NC组;HIE患儿随着病情程度增加,Vs、Vd、Vm相对越低,RI相对越高,差异均有统计学意义(P<0.05);HIE组在出生后28 d随访复查TCD和NBNA,轻、中、重度三组患儿的NBNA评分差异有统计学意义(P<0.05),预后良好组患儿的Vs、Vd、Vm显著高于预后不良组(P<0.05),RI显著低于预后不良组(P<0.05);Pearson相关分析显示,MCA血流动力学Vs、Vd、Vm与NBNA评分呈正相关(P<0.05),RI与NBNA呈负相关(P<0.05)。结论HIE患儿普遍具有脑动脉阻力升高及低脑血流灌注,TCD动态观察HIE患儿的脑血流动力学变化过程对早期诊断及预后评价具有重要价值。

Characteristics of Cerebral Blood Flow of Ultrasound in Neonates With Hypoxic Ischemic Encephalopathy and the Relationship with Clinical Prognosis

Objective To investigate the characteristics of cerebral hemodynamics of transcranial color Doppler ultrasound(TCD)in neonatal hypoxic-ischemic encephalopathy(HIE)and its relationship with clinical prognosis.Methods A total of 136 newborns with HIE were selected as the HIE group,100 healthy newborns were randomly selected as the control group(NC group).TCD was used to measure the diastolic flow velocity(Vd),peak systolic flow velocity(Vs),and average flow velocity(Vs)of the middle cerebral artery(MCA).HIE group was followed up to 28 days after birth and NBNA score was performed.Results At 24 h and 48 h of birth,HIE group newborns had significantly slower cerebral blood flow velocity and significantly increased resistance index.Vs,Vd,and Vm of MCA were significantly lower than those of NC group,and RI were significantly higher than those of NC group(P<0.05).72 h after birth,there was no significant difference in hemodynamic parameters between the mild HIE group and the NC group(P>0.05),and the Vs,Vd,and Vm of the moderate and severe HIE groups were significantly lower than those of the NC group.The RI was significantly higher than that in the NC group.With the increase of the condition of children with HIE,the lower the Vs,Vd,and Vm and the higher the RI,the differences were statistically significant(P<0.05).The NBNA scores of children with mild,moderate,and severe groups were statistically significant(P<0.05).Vs,Vd,and Vm of children with good prognosis were significantly higher than those with poor prognosis(P<0.05),and RI was significantly lower than poor prognosis group(P<0.05).Pearson correlation analysis showed that MCA hemodynamics Vs,Vd,Vm were positively correlated with NBNA scores(P<0.05),and RI was negatively correlated with NBNA(P<0.05).Conclusions Neonates with HIE generally have elevated cerebral arterial resistance and low cerebral blood flow perfusion.TCD can dynamically observe the change of HIE,which is of great value for early diagnosis and prognosis evaluation for HIE.