多普勒超声评价新生儿脑室周围-脑室内出血

摘要

Objective To assess the hemodynamics of middle cerebral artery (MCA) in different grades of neonatal periventricular-intraventricular hemorrhage (PIVH) with Doppler ultrasonography. Methods Totally 321 newborns who underwent routine cerebral ultrasonography were divided into control group (n = 83), grade Ⅰ PIVH group (n = 90), grade Ⅱ PIVH group (n=106), grade Ⅲ PIVH group (n=21) and grade Ⅳ PIVH group (n = 21). The hemodynamics of MCA were detected, including bilateral velocity systolic (Vs), velocity diastole (Vd) and resistance index (RI) , and hemo-dyniamic changes of MCA in each group were compared and analyzed. Results Within 1 week after delivery, there was a linear increase of Vs with the increasing of age. Vs of 3 days in grade Ⅰ PIVH group was lower than that in control group and grade I PIVH group (both P<0. 05), but higher than that in grade Ⅲ and Ⅳ PIVH groups (both P<0. 05). Vs of 7 days and Vd of 3 days in grade Ⅱ PIVH group were significantly higher than those in other PIVH groups (all P<0. 05). Vs of 7 days and Vd of 3 days in grade Ⅲ,Ⅳ PIVH groups were lower than those in grade Ⅰ , ⅡPIVH groups and control group (all P<0. 05). The difference of blood flow velocity of MCA had no significant difference between grade Ⅲ and Ⅳ PIVH group (all P>0. 05). There was no significant difference of RI among all groups (all P>0. 05). Conclusion Doppler ultrasonography can monitor the progression of neonatal PIVH.%目的 探讨不同程度脑室周围-脑室内出血(PIVH)新生儿大脑中动脉(MCA)的血流动力学变化.方法 对321名出生1周内新生儿行颅脑超声检查,测定双侧MCA的收缩期峰值流速(Vs)、舒张期末流速(Vd)及阻力指数(RI).根据结果将新生儿分为对照组(83名)、PIVH Ⅰ级组(90例)、Ⅱ级组(106例)、Ⅲ级组(21例)和Ⅳ级组(21例),分析各组间MCA的血流动力学变化特点.结果 各组新生儿出生后1周内Vs均随着日龄增加而增高.PIVH Ⅰ级组新生儿3天内Vs明显低于对照组和PIVHⅡ级组(P均＜0.05),高于PIVHⅢ、Ⅳ级组(P均＜0.05)；PIVHⅡ级组新生儿7天内Vs及3天内Vd明显高于其他各组(P均＜0.05)；PIVHⅢ、Ⅳ级组新生儿7天内Vs及3天内Vd显著低于对照组和PIVH Ⅰ、Ⅱ级组(P均＜0.05),PIVHⅢ、Ⅳ级组间比较血流参数差异无统计学意义(P均＞0.05).各组间RI差异无统计学意义(P均＞0.05).结论 多普勒超声可动态监测PIVH患儿MCA血流动力学变化.