床旁彩色多普勒超声动态监测新生儿脑室周围-脑室内出血的价值

摘要

目的 探讨床旁彩色多普勒超声在评估新生儿脑室周围-脑室内出血(periventricular-intraventrieular hemorrhages,PIVH)的临床价值.方法 以68例PIVH患儿和156例正常新生儿为研究对象,在出生1周内对其行动态超声监测,同时监测大脑中动脉(MCA)收缩期峰速(Vs)、舒张末期速度(Vd)、阻力指数(RI),比较上述三个参数在新生儿出生后1d、4d和7d时不同分级之间以及和正常新生儿的差异.结果 68例PIVH患儿全部由超声诊断.早产儿患病率高于足月儿,低出生体质量儿患病率高于正常出生体质量儿,差异均具统计学意义(P＜0.05).4组PIVH患儿Vs和Vd在出生1周内均呈增加趋势.Vs:Ⅰ级患儿4d和7d时与正常新生儿比较,差异无统计学意义(P＞0.05);另外三组1d、4d和7d时与正常新生儿组比较,差异均具统计学意义(P＜0.05).Vd:Ⅱ级患儿7 d内均要高于其他4组新生儿,差异均具统计学意义(P＜0.05);Ⅲ级和Ⅳ级患儿7d内均小于正常新生儿,差异均具统计学意义(P＜0.05).各组间RI差异均无统计学意义(P＞0.05).结论 床旁多普勒对PIVH的诊断准确率较高,同时对新生儿血流动力的动态监测可为PIVH的发生和发展评估提供重要的依据.%Objective To investigate the clinical value of the bedside color Doppler in the assessment infants with periventricular-intraventricular hemorrhages (PIVH).Methods Sixty-eight cases of PIVH newborns and 156 healthy newborns were involved in the study,dynamic monitoring were undergone within a week after birth.The middle cerebral artery(MCA) hemodynamic parameters of velocity systolic (Vs),velocity diastolic(Vd) and resistance index (RI) were recorded,and the differences of the parameters were compared between different grades as well as those of the normal newborns at 1 d,4 d and 7 d after born.Results Total 68 PIVH infants were diagnosed by bedside color Doppler accurately.Prevalences of premature and low birth weight infants were higher than term infants and normal birth weight children,respectively (P ＜0.05).Vs and Vd of 4 groups of children with PIVH showed an increasing trend in a week after born.The differences of Vs between grade Ⅰ and normal newborns in 4 d and 7 d were not statistically significant (P＞ 0.05),the differences of the other three groups compared with normal newborn group in1 d,4 d and 7 d were statistically significant (P ＜0.05).Vd of grade Ⅱ newborns within 7 d were greater than those of other 4 groups (P ＜0.05),grade Ⅲ and grade Ⅳ within 7 d were less than healthy newborns (P ＜0.05).The difference of RI between all groups were not statistically significant (P ＞ 0.05).Conclusions The diagnostic accuracy rate of PIVH by bedside Doppler is high and the dynamic monitoring of neonatal hemodynamics could provide an important basis for assessing the occurrence and development of PIVH.