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目的探讨新生儿缺氧缺血性脑病(HIE)脑氧利用率(O2UCc)的动态变化及临床意义。方法将45例HIE患儿依据病情分为三组轻度(A组)、中度(B组)、重度(C组)各15例,另设健康足月儿20例为正常对照组。HIE组分别于入院时、生后24 h、48 h、72 h、7 d、出院时或死亡前采集桡动脉和颈内静脉血各2 m。l对照组,在出生后24 h内采集桡动脉和颈内静脉各2 m。l采血后立即做血气分析,测定血氧饱和度SO2,计算O2UCc。结果HIE组患者在入院时及24 h内的脑氧利用率均显著高于正常对照组(P<0.01)。其中24 h内HIE组各组之间两两比较亦有显著差异(P<0.01),中重度HIE组明显高于轻度组。各组HIE患儿的O2UCc在入院后逐渐降低到生后72 h基本达最低,尤以重度组更明显,以后逐渐升高至正常。轻度组O2UCc在48 h后与正常对照组差异无统计学意义(P>0.05),中度组O2UCc在72 h后与正常对照组差异无统计学意义(P>0.05),重度组O2UCc在7 d后与正常对照组差异无统计学意义(P>0.05)。结论脑氧利用率动态监测可作为判断HIE患儿脑组织缺氧、微循环障碍、病情严重程度和近期预后的重要指标。
Objective To investigate the dynamic changes and clinical significance of cerebral oxygen utilization (O2UCc) in neonates with hypoxic-ischemic encephalopathy (HIE). Methods Forty-five HIE children were divided into three groups: mild (group A), moderate (group B) and severe (group C), and 20 healthy full-term infants were selected as normal control group. HIE group were collected at admission, after birth, 24 h, 48 h, 72 h, 7 d, before discharge or death of the radial artery and jugular vein blood collected 2 m. In the control group, radial artery and internal jugular vein were collected within 24 h after birth, each 2 m. Blood gas analysis immediately after blood collection, determination of oxygen saturation SO2, calculate O2UCc. Results The cerebral oxygen utilization rate in HIE group was significantly higher than that in normal control group at admission and within 24 h (P <0.01). There was also a significant difference (P <0.01) between the two groups in each group of HIE within 24 h, and moderate to severe HIE group was significantly higher than that in mild group. The O2UCc in HIE children in each group decreased gradually after admission to 72 hours after birth, the basic minimum, especially in severe group more obvious, and then gradually increased to normal. There was no significant difference of O2UCc between the mild group and the normal control group after 48 h (P> 0.05), while there was no significant difference between the moderate group and the normal control group (P> 0.05) After 7 days, there was no significant difference with normal control group (P> 0.05). Conclusion The dynamic monitoring of cerebral oxygen utilization rate can be used as an important index for judging the brain hypoxia, microcirculation disturbance, severity of illness and recent prognosis in children with HIE.