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目的 探讨新生儿缺氧缺血性脑病 (HIE)脑血流的变化规律。方法 应用彩色多普勒能量图 (CDE)对 3 4例HIE患儿及 2 5例正常新生儿的大脑内侧面上部边缘血管网及脑动脉血流参数进行了对照观察。结果 在生后 2 4h内 ,HIE患儿脑血流灌注减少 ,大脑内侧面上部边缘小动脉血流直径缩小 ,网络稀疏 ,甚至难以显示 ;脑动脉流速较正常显著下降 ,阻力指数显著增高 (P <0 .0 1)。之后 ,除了 2例重度患儿持续“少灌注”状态而死亡外 ,其余患儿脑血流灌注开始增加 ,大脑内侧面上部边缘小动脉血流直径扩大 ,血管网络逐渐恢复 ,脑动脉流速增加 ,阻力指数下降。从 2 4～ 96h ,中重度患儿中有 9例呈现“多灌注”损伤表现 ,患儿病情及脑水肿声像图征象均加重 ,边缘小动脉血流直径及各流速参数亦大于正常 (P <0 .0 5 )。其余患儿则未观察到“多灌注”损伤表现。结论 用CDE监测HIE患儿大脑内侧面上部边缘血管网及脑动脉血流参数 ,对判断“少灌注”损伤有重要价值。对是否存在“多灌注”损伤 ,尚需结合临床表现及脑声像图综合判断 ,才能得出正确结论
Objective To investigate the changes of cerebral blood flow in neonates with hypoxic-ischemic encephalopathy (HIE). Methods Color Doppler energy imaging (CDE) was used to compare the blood flow parameters of the superior border of the brain and cerebral artery in 34 neonates with HIE and 25 normal neonates. Results Within 24 hours after birth, cerebral perfusion was decreased in HIE infants. The diameter of the arterial blood flow in the upper edge of the medial side of the brain was reduced, and the network was sparse and even difficult to be displayed. The flow velocity of cerebral artery decreased significantly and the resistance index increased significantly (P <0 .0 1). After that, except for 2 cases of severe infants who died in the state of “little perfusion”, the other children started to increase cerebral blood flow, the diameter of the arterial blood flow in the upper part of the medial side increased, the blood vessel network gradually recovered, Resistance index decreased. From 24 to 96 hours, 9 cases of moderate and severe children showed “multiple perfusion” injury. The sonography and cerebral edema of the children showed aggravate signs, and the diameters and velocity parameters of the marginal arterioles were also larger than the normal <0 .0 5). The remaining children did not observe the “perfusion” injury performance. Conclusions CDE can be used to monitor the blood flow in the superior border of brain and blood flow in the brain of HIE children. It is of great value to judge the damage of “less perfusion”. The existence of “perfusion” damage, still need to be combined with clinical manifestations and brain sound image synthesis judgment, can come to the correct conclusion