中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
6期
446-450
,共5页
陆丹芳%童笑梅%刘云峰%葛迎年%冯新恒%张华
陸丹芳%童笑梅%劉雲峰%葛迎年%馮新恆%張華
륙단방%동소매%류운봉%갈영년%풍신항%장화
早产儿%动脉导管未闭%血流动力学%脑室周围-脑室内出血%颅脑超声
早產兒%動脈導管未閉%血流動力學%腦室週圍-腦室內齣血%顱腦超聲
조산인%동맥도관미폐%혈류동역학%뇌실주위-뇌실내출혈%로뇌초성
Premature infant%Patent ductus arteriosus%Haemodynamics%Periventricular-intraventricular hemorrhages%Transcranial sonography
目的 研究早产儿动脉导管未闭(PDA)对脑血流动力学的影响及其与脑室周围-脑室内出血(PIVH)的相关性.方法 对85例胎龄≤34周、出生体质量≤2 000 g的早产儿进行前瞻性病例-对照研究,在其出生后至48 h、48 ～ 96 h、96～ 120 h、120 ～ 168 h进行床旁超声心动图和颅脑超声检查,监测有无PDA发生和大脑前、中动脉(ACA、MCA)的收缩期峰流速(Vs)、舒张末期流速(Vd)、平均流速(Vm)、搏动指数(PI)和阻力指数(RI),观察有无PIVH的发生.结果 根据出生后72 h内的超声心动图结果及相应临床症状,将观察对象分为以下3组:(1)有血流动力学意义的PDA组(hsPDA组)23例;(2)无血流动力学意义的PDA组(nhsPA组)38例;(3)无PDA组(non-PDA,nPDA组)24例.3组在胎龄、体质量方面差异无统计学意义.单因素及多因素Logistic回归分析发现出生后48 h内有创机械通气与hsPDA有相关性(x2=11.182,P=0.019; OR=10.06,P=0.039);对3组脑血流动力学参数进行重复测量方差分析发现hsPDA组大脑ACA、MCA的Vd值显著低于nhsPDA组(P=0.000,P=0.001)和nPDA组(P =0.003,P =0.013),而ACA、MCA的搏动指数(PI)、阻力指数(RI)值显著高于其他2组.hsPDA组在出生后7d复查,PDA关闭组(n=7)的RI、PI值较未闭组(n=16)降低,而Vd值升高;生后7 d PDA关闭组与nPDA组(n=24)比较各血流参数的差异无统计学意义.PDA关闭与否各组间PIVH的严重程度差异无统计学意义,然而hsPDA组发生重度PIVH的比例高于其他2组(17.39％比8.33％比5.26％,x2=2.405,P=0.280).结论 早产儿出生后48 h内有创机械通气与发生hsPDA有相关性;早产儿hsPDA可造成脑血流动力学变化,并可能增加重度PIVH的发生率.
目的 研究早產兒動脈導管未閉(PDA)對腦血流動力學的影響及其與腦室週圍-腦室內齣血(PIVH)的相關性.方法 對85例胎齡≤34週、齣生體質量≤2 000 g的早產兒進行前瞻性病例-對照研究,在其齣生後至48 h、48 ～ 96 h、96～ 120 h、120 ～ 168 h進行床徬超聲心動圖和顱腦超聲檢查,鑑測有無PDA髮生和大腦前、中動脈(ACA、MCA)的收縮期峰流速(Vs)、舒張末期流速(Vd)、平均流速(Vm)、搏動指數(PI)和阻力指數(RI),觀察有無PIVH的髮生.結果 根據齣生後72 h內的超聲心動圖結果及相應臨床癥狀,將觀察對象分為以下3組:(1)有血流動力學意義的PDA組(hsPDA組)23例;(2)無血流動力學意義的PDA組(nhsPA組)38例;(3)無PDA組(non-PDA,nPDA組)24例.3組在胎齡、體質量方麵差異無統計學意義.單因素及多因素Logistic迴歸分析髮現齣生後48 h內有創機械通氣與hsPDA有相關性(x2=11.182,P=0.019; OR=10.06,P=0.039);對3組腦血流動力學參數進行重複測量方差分析髮現hsPDA組大腦ACA、MCA的Vd值顯著低于nhsPDA組(P=0.000,P=0.001)和nPDA組(P =0.003,P =0.013),而ACA、MCA的搏動指數(PI)、阻力指數(RI)值顯著高于其他2組.hsPDA組在齣生後7d複查,PDA關閉組(n=7)的RI、PI值較未閉組(n=16)降低,而Vd值升高;生後7 d PDA關閉組與nPDA組(n=24)比較各血流參數的差異無統計學意義.PDA關閉與否各組間PIVH的嚴重程度差異無統計學意義,然而hsPDA組髮生重度PIVH的比例高于其他2組(17.39％比8.33％比5.26％,x2=2.405,P=0.280).結論 早產兒齣生後48 h內有創機械通氣與髮生hsPDA有相關性;早產兒hsPDA可造成腦血流動力學變化,併可能增加重度PIVH的髮生率.
목적 연구조산인동맥도관미폐(PDA)대뇌혈류동역학적영향급기여뇌실주위-뇌실내출혈(PIVH)적상관성.방법 대85례태령≤34주、출생체질량≤2 000 g적조산인진행전첨성병례-대조연구,재기출생후지48 h、48 ～ 96 h、96～ 120 h、120 ～ 168 h진행상방초성심동도화로뇌초성검사,감측유무PDA발생화대뇌전、중동맥(ACA、MCA)적수축기봉류속(Vs)、서장말기류속(Vd)、평균류속(Vm)、박동지수(PI)화조력지수(RI),관찰유무PIVH적발생.결과 근거출생후72 h내적초성심동도결과급상응림상증상,장관찰대상분위이하3조:(1)유혈류동역학의의적PDA조(hsPDA조)23례;(2)무혈류동역학의의적PDA조(nhsPA조)38례;(3)무PDA조(non-PDA,nPDA조)24례.3조재태령、체질량방면차이무통계학의의.단인소급다인소Logistic회귀분석발현출생후48 h내유창궤계통기여hsPDA유상관성(x2=11.182,P=0.019; OR=10.06,P=0.039);대3조뇌혈류동역학삼수진행중복측량방차분석발현hsPDA조대뇌ACA、MCA적Vd치현저저우nhsPDA조(P=0.000,P=0.001)화nPDA조(P =0.003,P =0.013),이ACA、MCA적박동지수(PI)、조력지수(RI)치현저고우기타2조.hsPDA조재출생후7d복사,PDA관폐조(n=7)적RI、PI치교미폐조(n=16)강저,이Vd치승고;생후7 d PDA관폐조여nPDA조(n=24)비교각혈류삼수적차이무통계학의의.PDA관폐여부각조간PIVH적엄중정도차이무통계학의의,연이hsPDA조발생중도PIVH적비례고우기타2조(17.39％비8.33％비5.26％,x2=2.405,P=0.280).결론 조산인출생후48 h내유창궤계통기여발생hsPDA유상관성;조산인hsPDA가조성뇌혈류동역학변화,병가능증가중도PIVH적발생솔.
Objective To investigate the cerebral haemodynamics change and morbidity of periventricular-intraventricular hemorrhages(PIVH) in premature infants with or without patent ductus ateriosus (PDA).Methods Bedside Echocardiography and transcranial sonography (TCS) were performed on 85 cases of preterm infants in 48 h,48 to 96 h,96 to 120 h,120 to 168 h after birth (gestational age≤34 weeks and birth weight≤2 000 g).PDA,peak systolic velocity (Vs),end-diastolic velocity (Vd),pulsatility index (PI) and resistant index (RI) of anterior and middle cerebral artery(ACA and MCA) and PIVH were monitored simutaneously.Results According to the Echocardiography and clinical symptoms,all the cases were divided into 3 groups:haemodynamic significant PDA group (hsPDA group,n =23),non-hsPDA group(nhsPDA group,n =38) and non-PDA group(nPDA group,n =24).The mean birth weight and gestational age did not differ significantly among the 3 groups.Single and multiple Logistic analysis indicated that invasive mechanical ventilation less than 48 h after birth was related to hsPDA (x2 =11.182,P =0.019; OR =10.06,P =0.039).Repetitive measurement deviation analysis found that:Vd of ACA and MCA were lower in the hsPDA group than those in the nhsPDA group (P =0.000,P =0.001) and the nPDA group (P =0.003,P =0.013),while PI and RI were higher than in the other 2 groups.Compared with non-closed group,at 7 days after birth in hsPDA group,RI and PI of closed group were significantly lower,while Vd was significantly higher.Nevertheless,there was no significant difference in hemodynamic parameters when comparison with nPDA group at 7 days after birth.There was no statistical difference in the grading and severity of PIVH with or without PDA.However,the rate of severe PIVH was found higher in hsPDA group than the other 2 groups(17.39％ vs 8.33％ vs 5.26％,x2 =2.405,P =0.280).Conclusions The invasive mechanical ventilation less than 48 h after birth was probably associated with preterm hsPDA.HsPDA could result in major cerebral haemodynamic changes and increase the morbidity of severe PIVH.
