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目的探讨应用颅脑多普勒超声早期测量大脑中动脉(MCA)血流速度在早产儿颅内出血(IVH)中的临床价值。方法选择2013年3月至2014年1月在我院产科出生后24 h内收入我院新生儿科、胎龄30~34周的早产儿。应用超声多普勒技术,测量生后24~72 h MCA的收缩期峰值血流速度(Vs)、舒张期峰值血流速度(Vd)、阻力指数(RI)和搏动指数(PI)等血流参数,根据有无IVH将入选早产儿分为IVH组和非IVH组,并将IVH组根据出血程度分为轻度组及重度组,比较不同组间患儿MCA的Vs、Vd、RI和PI的变化。结果共纳入65例早产儿,29例确诊为IVH,检出率44.6%,其中31.0%为重度出血。IVH重度组和轻度组生后早期Vs、Vd均高于非IVH组[Vs:(48.6±5.0)、(44.9±4.2)比(39.6±4.6)cm/s,Vd:(13.6±2.9)、(10.5±2.3)比(9.2±2.1)cm/s],重度组高于轻度组,差异有统计学意义(P<0.05);RI、PI低于非IVH组[RI:(0.68±0.01)、(0.75±0.04)比(0.80±0.06),PI:(1.37±0.20)、(1.55±0.25)(1.68±0.29)],重度组低于轻度组,差异有统计学意义(P<0.05)。结论早产儿早期IVH呈现脑血流的低阻力及高灌注现象,表现为MCA的Vs、Vd值增高和RI、PI值降低。生后早期动态监测早产儿MCA的血流参数变化,可一定程度预测IVH的发生并协助判断IVH程度。
Objective To investigate the clinical value of early measurement of blood flow velocity of middle cerebral artery (MCA) in intracranial hemorrhage (IVH) of premature infants by using Doppler echocardiography. Methods March 2013 to January 2014 in our hospital Obstetrics and Gynecology within 24 hours after birth in our hospital neonatal, gestational age 30 to 34 weeks of premature children. The blood flow velocity (Vs), diastolic peak velocity (Vd), resistance index (RI) and pulsatility index (PI) in MCA were measured 24 hours to 72 hours after birth by using Doppler ultrasound According to the presence or absence of IVH, the preterm infants were divided into IVH group and non-IVH group according to the presence or absence of IVH. IVH group was divided into mild group and severe group according to the degree of bleeding. Vs, Vd, RI and PI of children with MCA were compared The change. Results A total of 65 preterm infants were enrolled. 29 cases were diagnosed as IVH, the detection rate was 44.6%, of which 31.0% were severe bleeding. Vs and Vd in the severe IVH group and the mild group were higher than those in the non-IVH group [Vs: (48.6 ± 5.0), (44.9 ± 4.2) vs (39.6 ± 4.6) cm / , (10.5 ± 2.3) vs (9.2 ± 2.1) cm / s], respectively, and the difference between the severe group and the mild group was statistically significant (P <0.05) 0.01), (0.75 ± 0.04) vs (0.80 ± 0.06), PI (1.37 ± 0.20) and (1.55 ± 0.25) (1.68 ± 0.29), respectively <0.05). Conclusions Early IVH shows low resistance and high perfusion of cerebral blood flow, which shows the increase of Vs and Vd and the decrease of RI and PI in MCA. The early dynamic monitoring of preterm infants after premature infants MCA blood flow parameters can predict the occurrence of IVH to some extent and help determine the degree of IVH.