缺氧、窒息围产儿耳廓微循环观察

目的探讨缺氧、窒息与围产儿微循环障碍的关系.方法选择28例缺氧、窒息围产儿复苏后24h及72h进行耳廓微循环各项指标变化观察,对照组选择30例正常足月新生儿于生后24h及72h分别进行耳廓微循环观察.结果两组比较,24h耳廓微循环中微血管畸形率及RBC聚集率有高度显著差异(P均＜0.01);两组间白微栓出现率及细静脉流速经统计学处理具显著性差异(P均＜0.05).复苏后72h,两组相比较,除RBC聚集率及白微栓出现率差异无显著性外(P均＞0.05),微血管畸形率及细静脉流速仍具显著性差异(P均＜0.05).窒息患儿复苏后24h与72h相比,耳廓微循环中白微栓出现率及细静脉流速具有显著性差异(P均＜0.05).微血管畸形率及RBC聚集率差异无显著性(P＞0.05).结论胎儿宫内窘迫及新生儿窒息可导致围产儿早期耳廓微循环障碍,对这些围产儿进行早期耳廓微循环动态检测,可与NBNA结合,对判断窒息、缺氧时脑损伤程度及患儿预后有一定临床实用价值.

Observation on Auricular Microcirculation in Perinatal Newborns with Hypoxia or Asphyxia

Objective To explore the relationship between hypoxia, asphyxia in perinatal neonates and the disturbances in microcirculation.Methods 28 perinatal newborns with hypoxia, asphyxia were selected. Their auricular microcirculation was observed both in 24 hours and in 72 hours. 30 cases of normal newborn babies were selected as control group.Results At 24 hrs, there was marked difference between the two groups in both microvascular deformity rate and RBC aggregation rate in the auricular microcirculation of the newborns(P<0.01). There were also significant differences between the two groups in both white microthrombus appearing rate and velocity of flow in the auricular venules(P<0.05).At 72 hrs,there were still remarkable differences between them in micro_vascular deformity rate and velocity of flow in venules (P<0.05),but there was no difference in RBC aggregation rate and white microthrombus appearing rate(P>0.05). In newborns with asphyxia, compared 24 hrs after resuscitation with 72 hrs after resuscitation, there were striking differences in white microthrombus appearing rate and velocity of flow in venules in auricular microcirculation(P<0.05).However, there were no differences between two different age groups in micro_vascular deformity rate and RBC aggregation rate (P>0.05). Conclusions Both fetal distress and neonatal asphyxia may lead to marked auricular microcirculation disturbances in the early perinatal stage. For those babies who had either fetal distress or asphyxia may monitor their auricular microcirculation constantly and combined with NBNA. it may have clinical value to estimate the prognosis of the newborns with asphyxia or hypoxia.