CAJ | 학술논문

目的探讨新生儿缺氧缺血性脑病(HIE)脑血流的变化规律.方法应用彩色多普勒能量图(a)E)对34例HIE患儿及25例正常新生儿的大脑内侧面上部边缘血管网及脑动脉血流参数进行了对照观察.结果在生后24 h内,HIE患儿脑血流灌注减少,大脑内侧面上部边缘小动脉血流直径缩小,网络稀疏,甚至难以显示;脑动脉流速较正常显著下降,阻力指数显著增高(P<0.01).之后,除了2例重度患儿持续"少灌注"状态而死亡外,其余患儿脑血流灌注开始增加,大脑内侧面上部边缘小动脉血流直径扩大,血管网络逐渐恢复,脑动脉流速增加,阻力指数下降.从24～96 h,中重度患儿中有9例呈现"多灌注"损伤表现,患儿病情及脑水肿声像图征象均加重,边缘小动脉血流直径及各流速参数亦大于正常(P<0.05).其余患JL~tl未观察到"多灌注"损伤表现.结论用CDE监测HIE患儿大脑内侧面上部边缘血管网及脑动脉血流参数,对判断"少灌注"损伤有重要价值.对是否存在"多灌注"损伤,尚需结合临床表现及脑声像图综合判断,才能得出正确结论.
목적 탐토신생인결양결혈성뇌병(HIE)뇌혈류적변화규률.방법 응용채색다보륵능량도(a)E)대34례HIE환인급25례정상신생인적대뇌내측면상부변연혈관망급뇌동맥혈류삼수진행료대조관찰.결과 재생후24 h내,HIE환인뇌혈류관주감소,대뇌내측면상부변연소동맥혈류직경축소,망락희소,심지난이현시;뇌동맥류속교정상현저하강,조력지수현저증고(P<0.01).지후,제료2례중도환인지속"소관주"상태이사망외,기여환인뇌혈류관주개시증가,대뇌내측면상부변연소동맥혈류직경확대,혈관망락축점회복,뇌동맥류속증가,조력지수하강.종24～96 h,중중도환인중유9례정현"다관주"손상표현,환인병정급뇌수종성상도정상균가중,변연소동맥혈류직경급각류속삼수역대우정상(P<0.05).기여환JL~tl미관찰도"다관주"손상표현.결론 용CDE감측HIE환인대뇌내측면상부변연혈관망급뇌동맥혈류삼수,대판단"소관주"손상유중요개치.대시부존재"다관주"손상,상수결합림상표현급뇌성상도종합판단,재능득출정학결론.
Objective To study the cerebral blood flow changes of neonates with hypoxic-ischemic encephalopathy(HIE).Methods The arteriosum fete of upper border of medial surface of the cerebral hemisphere(ARUMS)and the blood flow parameters of cerebral arteries(CA)in 34 neonates with HIE and 25 health neonates were observed and compared by color Doppler energy image(CDE).Results The cerebral perfusion of neonates with HIE were decreased within 24 h after birth.the blood flow diameters of arteriolae of ARUMS were redUCed,and the ARUMS were few and scattered,even it were hardly showed;The velocity of CA wasdecreased and resistance index(RI)WaS significantly rised compared with health neonates(P<0.01). Afterwards,except for 2 severe cases,who were in continuous hypoperfusion and died,in the others,the cerebral perfusion started to be increased,the blood flow diameters of arteriolae of ARUMS were dilated,the ARUMS WaS recovered gradually,the velocity of CA WaS increased,and R1 waS decreased.From 24 to 96 h,9 cases in the moderate and severe groups show"luxury perfusion damage":the condition and the ultrasonographic in brain edema sign of these cases became more severe.and the blood flow diameters of arteriolae of ARUMS and all of velocity parameters were also increased over normal(P<0.05).But this phenomenon WaS not observed in other cas.Conclusions The monitoring ARUMS and blood flow parameters of CA of HIE by CDE is important in judging the"hypoperfusion damage".But it had to combine clinical manifestation with brain ultrasonography to judge whether the"luxury perfusion damage"exists.