| 摘要: |
| 目的 探究NRDS对脑血流动力学相关指标的影响及其随治疗的改变情况,以期为临床早期诊断和预防NRDS继发的脑损伤提供参考。方法 前瞻性选取 2019年1月至6月于空军军医大学唐都医院产科出生的新生儿123例,其中, NRDS患儿42例(病例组)、健康足月儿49例(对照组)、健康早产儿32例(对照组)。所有新生儿均在出生后24-48小时内行颅脑超声检查,测量额叶厚度及脑横径,观察脑实质有无出血等改变,并测定大脑中动脉(MCA)血流频谱参数包括：收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均流速(MFV)、阻力指数(RI)、搏动指数(PI)。在入选的42例NRDS患儿中,有25例接受外源性肺表面活性物质(PS)治疗,患儿用药后1天复查颅脑超声并测量上述脑血流动力学指标。结果 健康早产儿和足月新生儿比较,MCA血流速度减慢,EDV、MFV均降低,差异有显著性意义(P＜0.01,P＜0.05),RI、PI均升高(P＜0.01,P＜0.01)；NRDS患儿和健康足月儿比较,PSV、EDV、MFV均明显减慢(P＜0.001),而RI和PI无明显变化；NRDS患儿和健康早产儿比较,脑血流速度及RI、PI均无明显变化(P＞0.05)。NRDS患儿在使用外源性PS治疗后,PSV、RI较治疗前显著降低(P<0.05),而EDV、MFV及PI均无明显变化(P>0.05)。结论 NRDS患儿的低氧血症状态及使用外源性PS治疗后均会对脑血流动力学造成影响,二维及多普勒超声可以清晰地显示新生儿脑实质,并有效检测脑血流速度变化,为NRDS患儿脑损伤的临床治疗及预防提供一定的参考依据。 |
| 关键词: 新生儿呼吸窘迫综合征 脑血流动力学 超声检查 肺表面活性物质 |
| DOI： |
| 投稿时间：2019-10-14修订日期：2019-11-01 |
| 基金项目:陕西省自然科学基础研究计划 |
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| Application of two-dimensional and Doppler ultrasound in cerebral hemodynamic detection of neonatal respiratory distress syndrome. WANG Ding-yi1 WANG Zhen 2 YANG Run-run1 LIANG Yuan1 DU Jing-xi1 DUAN Yun-you1 YANG Yong1 |
| wangdingyi,yangyong,wangzhen,yangrunrun,liangyuan,dujingxi,duanyunyou |
| () |
| Abstract: |
| Objective To explore the influence of NRDS on cerebral hemodynamics and its changes with treatment, so as to provide references for early clinical diagnosis and prevention of brain damage secondary to NRDS. Methods From January to June 2019, a total of 123 neonates born in obstetrics department of Tangdu Hospital of the Air Force Military Medical University were prospectively divided into three groups, including 42 NRDS infants (case group), 49 healthy full-term infants (control group), and 32 healthy premature infants (control group). Cerebral ultrasonic examination was performed for all newborns in 24 to 48 hours after birth, measuring the thickness of the frontal lobe and transverse diameter, observing parenchymal hemorrhage or not, recording blood flow spectrum parameters of middle cerebral artery (MCA) including the peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MFV), resistance index (RI) and pulse index (PI). Among the 42 selected neonates with NRDS, 25 patients received exogenous pulmonary surfactant (PS) and craniocerebral ultrasound was re-examined for them after treated with the drug. Results Compared with full-term newborns, EDV and MFV of healthy premature infants decreased and the difference was significant (P < 0.01, P < 0.05), while RI and PI increased (P < 0.01, P < 0.01). Compared with healthy infants, PSV、EDV and MFV of NRDS children were significantly decreased (P < 0.001), while RI and PI showed no significant change. Compared with healthy premature infants, there was no significant change of cerebral blood flow velocity、RI and PI of NRDS neonates (P > 0.05). After application of exogenous PS, PSV and RI in neonates with NRDS were significantly lower than that before treatment (P<0.05), while EDV, MFV and PI showed no significant changes (P>0.05). Conclusions Hypoxemia status of NRDS newborns and the use of exogenous PS could affect cerebral hemodynamics. Two-dimensional and Doppler ultrasound could clearly show the neonatal brain parenchyma, and effectively detect changes of cerebral blood flow velocity, providing a certain reference basis for the clinical prevention and treatment of brain injury in newborns with NRDS. |
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