围产期窒息新生儿的脑血流动力学异常与预后的关系。
Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome.
作者信息
Meek J H, Elwell C E, McCormick D C, Edwards A D, Townsend J P, Stewart A L, Wyatt J S
机构信息
Department of Paediatrics The Rayne Institute University College London Medical School London WC1E 6JJ.
出版信息
Arch Dis Child Fetal Neonatal Ed. 1999 Sep;81(2):F110-5. doi: 10.1136/fn.81.2.f110.
AIM
To measure changes in cerebral haemodynamics during the first 24 hours of life following perinatal asphyxia, and relate them to outcome.
METHODS
Cerebral blood volume (CBV), its response (CBVR) to changes in arterial carbon dioxide tension (PaCO(2)), and cerebral blood flow (CBF) were measured using near infrared spectroscopy (NIRS) in 27 term newborn infants with clinical and/or biochemical evidence consistent with perinatal asphyxia.
RESULTS
Both CBF and CBV were higher on the first day of life in the infants with adverse outcomes, and a CBV outside the normal range had a sensitivity of 86% for predicting death or disability. The mean (SD) CBVR on the first day of life was 0.13 (0.12) ml/100 g/1/kPa, which, in 71% of infants, was below the lower 95% confidence limit for normal subjects.
CONCLUSION
An increase in CBV on the first day of life is a sensitive predictor of adverse outcome. A reduction in CBVR is almost universally seen following asphyxia, but is not significantly correlated with severity of adverse outcome.
目的
测量围产期窒息后出生后24小时内脑血流动力学的变化，并将其与预后相关联。
方法
使用近红外光谱（NIRS）对27名足月儿进行测量，这些足月儿有临床和/或生化证据表明存在围产期窒息，测量指标包括脑血容量（CBV）、其对动脉二氧化碳分压（PaCO₂）变化的反应（CBVR）以及脑血流量（CBF）。
结果
预后不良的婴儿在出生第一天时CBF和CBV均较高，CBV超出正常范围对预测死亡或残疾的敏感性为86%。出生第一天时CBVR的均值（标准差）为0.13（0.12）ml/100g/1/kPa，71%的婴儿该值低于正常受试者的95%置信下限。
结论
出生第一天时CBV增加是不良预后的敏感预测指标。窒息后几乎普遍可见CBVR降低，但与不良预后的严重程度无显著相关性。
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