彩色多普勒超声在评估新生儿缺氧缺血性脑病预后中的价值

目的探讨彩色多普勒超声检查在估计新生儿缺氧缺血性脑病(HIE)预后的价值。方法应用彩色多普勒超声及二维超声检查对22例临床诊断为缺氧缺血性脑病的新生儿和10例正常新生儿于出生后1,2,3及4 d的脑血流参数、侧脑室及脑实质的二维声像改变进行了追踪观察,并于3 d内进行了颅脑CT检查。结果窒息新生儿生后第1天脑动脉的血流频谱及血流动力学参数有明显变化,阻力指数表现为不同的变化形式;窒息新生儿生后第1,2天侧脑室未显示率前角为63%,30%,体部分别为54%,25%,并有脑实质广泛回声增强;严重者3天后见增强的脑实质回声分布不均匀,逐渐呈团块状改变,20~30 d后复查,脑白质软化呈网状样改变;蛛网膜下腔出血15例,侧脑室出血5例,脑实质出血1例。结论RI是反映脑血管调节功能的指标,脑动脉RI升高是脑缺血的的表现,RI降低是脑过度灌注的标志,当RI等于1或<0.5时可提示预后较差。脑实质回声持续增强且分布不均匀呈团块状是脑白质软化的早期改变。彩色多普勒超声检查是判断新生儿HIE预后的重要方法之一。

Value of color Doppler ultrasound in evaluating the prognosi of neonatal hypoxic ischemic encephalopathy

Objective:To discuss the value of ultrasonic examination by color Doppler's method in eval-uating the prognosis of neonatal hypoxic ischemic encephalopathy(HIE).Methods:We pursued observe the cerebral blood stream parameter,bi-dimension sound aerial image alteration of lateral ventricle and cerebral parenchymal on22cases of infants clinically diagnosed hypoxic ischemic encephalopathy and10cases of normal newborns on the first,second,third,and fourth day after born by color Doppler ultrasound and bi-di-mension ultrasound examination and checking the brain and skull by computer tomography(CT)examination in3ways.Results:There is obvious change in the cerebral arterial blood stream and hemodynamics of the asphyxia newborns on the first day after born.Resistant index(RI)varied in different style.The rate of ante-rior horn without display is63%,30%,body part is54%,25%respectively and the echo of cerebral parenchyma extensively reinforced in asphyxia neonatals on the first and second day after born.Moreover,the echo of strong cerebral parenchyma was maldistributed and gradually took on massive appearance in severe patients.Cerebral white matter softening took on reticulum by re-examination after20~30days;15cases of subarachnoid hemorrhage,5cases of lateral ventricle hemorrhage,1case of cerebral parenchyma hemorrhage,respectively.The prognosis is fairly bad when RI equals1or less than0.5.Conclusions:RI is a target re-flecting the cerebral vein adjust.RI is the marker of cerebral ischemia.The reduction of RI is the marker of brain super-filling.It can show a better prognosis when RI equal1or less than0.5.Multicolor ultrasonic ex-amination by Doppler's method is one of the important methods judging the prognosis of neonatal hypoxic is-chemic encephalopathy.RI is the marker reflecting the regulating function of cerebral vessels.