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目的 研究新生儿缺氧缺血性脑病 (HIE)的发病机制及脑血流动力学的变化 ,并对东莨菪碱在治疗HIE的作用机制进行探讨。方法 用超声多普勒方法测定 5 1例使用东莨菪碱的HIE患儿 (HIE观察组 )和 4 8例非HIE患儿 (非HIE对照组 )在生后 3日龄和 7日龄双侧大脑前动脉 (ACA)、大脑中动脉 (MCA)和大脑后动脉(PCA)的血流动力学指标 ;同时测定 6 0例未使用东莨菪碱的HIE患儿 (HIE对照组 )的各动脉血流动力学参数。结果 3日龄时HIE观察组脑血流速度较非HIE对照组普遍降低 ,以双侧ACA(P <0 0 5 )和左侧PCA(P <0 0 1)的降低最为明显 ,7日龄时HIE观察组双侧ACA流速恢复 ,仅左侧PCA血流速度仍明显低于非HIE对照组 (P <0 0 5 ) ;7日龄时HIE观察组双侧ACA、MCA和PCA各血流参数均较HIE对照组有明显的改善。结论 HIE患儿的ACA、MCA、PCA流速普遍降低 ,以ACA和PCA最甚 ,且与HIE损伤的部位相一致 ;东莨菪碱可明显改善HIE患儿的脑血流动力学 ,从而阻断了脑细胞缺氧性损伤与脑血流动力异常之间的恶性循环。
Objective To study the pathogenesis and cerebral hemodynamics of neonatal hypoxic-ischemic encephalopathy (HIE) and to explore the mechanism of scopolamine in the treatment of HIE. Methods Fifty-one children with HIE treated with scopolamine (HIE observation group) and 48 children without HIE (non-HIE control group) were enrolled in this study. (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA). The hemodynamic parameters of 60 patients with HIE who did not use scopolamine (HIE control group) . Results At 3 days of age, the cerebral blood flow velocity in HIE observation group was generally lower than that in non-HIE control group, with the most obvious reduction being bilateral ACA (P <0.05) and left PCA (P <0 0 1) At the same time, the blood flow velocity of bilateral ACA in the HIE observation group was recovered, but the left PCA flow velocity was still lower than the non-HIE control group (P <0.05); on the 7th day, the bilateral ACA, MCA and PCA blood flow Parameters were significantly improved compared with the HIE control group. Conclusions The flow rate of ACA, MCA and PCA in children with HIE is generally decreased, and ACA and PCA are the most common, which is consistent with the site of HIE injury. Scopolamine can significantly improve cerebral hemodynamics in children with HIE and thus block brain cells Hypoxic injury and cerebral blood flow abnormalities between the vicious circle.