缺氧缺血性脑病新生儿的颅脑超声参数变化及与病情严重程度和预后的关系分析

目的 观察缺氧缺血性脑病新生儿(HIE)颅脑超声参数变化情况,并分析其颅脑超声参数变化与病情严重程度和预后的关系。方法 选取2022年2月-2022年11月本院新生儿重症监护病房收治的75例HIE患儿,根据其病情分度分为轻度组(38例) ,中度组(24例),重度组(13例)。并选取同期健康新生儿75例作为对照组。均于出生48h及72h分别行经颅彩色多普勒超声(TCD),收集其脑血流动力学相关参数,比较各组间差异。对HIE患儿进行28d的随访,再次进行TCD复查及预后评估,利用Peason相关性分析相关性。结果 出生48h 收缩期血流速度峰值(Vs)、舒张末期血流速度(Vd)、平均流速(Vm)：对照组>轻度组>中度组>重度组(均P<0.05);出生48h 阻力指数(RI)：对照组<轻度组<中度组<重度组(均P<0.05)。轻度组出生72h各参数均与对照组比较无差异(均P<0.05);出生72h Vs、Vd、Vm：对照组>中度组>重度组(均P<0.05);出生72h RI：对照组<中度组<重度组(均P<0.05)。预后不良者出生28d的新生儿行为神经测定(NBNA)量表评分、Vs、Vd、Vm均低于预后良好者,RI高于预后良好者(均P<0.05)。HIE患儿出生28d后的Vs、Vd、Vm均与NBNA评分呈正相关(r=0.493,0.434,0.432,P<0.05),RI与NBNA评分呈负相关(r=-0.478,P<0.05)。结论 HIE患儿TCD脑血流动力学参数Vs、Vd、Vm随着病情程度的加重呈降低趋势,RI呈升高趋势;TCD脑血流动力学参数监测可较为客观的反映HIE患儿脑血流灌注变化情况,且对其预后评价均具有一定的指导意义。

Changes of craniocerebral ultrasound parameters and their relationship with disease severity and prognosis in neonates with hypoxic-ischemic encephalopathy

Objective To observe the changes of craniocerebral ultrasound parameters in neonates with hypoxic-ischemic encephalopathy (HIE), and to analyze the relationship between the above changes and disease severity, prognosis. Methods A total of 75 children with HIE admitted to neonatal intensive care unit of the hospital were enrolled between February and November 2022. According to disease severity, they were divided into mild group (38 cases), moderate group (24 cases) and severe group (13 cases). A total of 75 healthy neonates during the same period were enrolled as control group. At 48h and 72h after birth, all underwent transcranial Doppler sonography (TCD). The relevant parameters of cerebral hemodynamics were collected, and their differences among all the groups were compared. HIE children were followed up for 28d, and then they were given TCD reexamination and prognosis assessment. The correlation was analyzed by Peason method. Results At 48h after birth, peak systolic velocity (Vs), end-diastolic velocity (Vd) and mean velocity (Vm) were the highest in control group, followed by mild group, moderate group and severe group (P<0.05), while resistance index (RI) was on the contrary (P<0.05). At 72h after birth, there was no significant difference in all parameters between mild group and control group (P<0.05). At 72h after birth, Vs, Vd and Vm were the highest in control group, followed by moderate group and severe group (P<0.05), while RI was on the contrary (P<0.05). At 28d after birth, score of neonatal behavioral neurological assessment (NBNA), Vs, Vd and Vm in patients with poor prognosis were all lower than those with good prognosis, while RI was higher than that with good prognosis (P<0.05). At 28d after birth, Vs, Vd and Vm were positively correlated with NBNA score (r=0.493,0.434,0.432, P<0.05), while RI was negatively correlated with it (r=-0.478, P<0.05). Conclusion With the aggravation of disease, Vs, Vd and Vm decrease, while RI increases in HIE children. The monitoring of TCD cerebral hemodynamics parameters can objectively reflect the changes of cerebral blood perfusion, and all have certain guidance significance for prognosis evaluation.