Noone M A, Sellwood M, Meek J H, Wyatt J S
Department of Paediatrics, Royal Free and University College Medical School, London, UK.
Acta Paediatr. 2003 Sep;92(9):1079-84.
To determine cerebral blood flow using near infrared spectroscopy in extremely preterm infants undergoing high-frequency oscillatory ventilation during the first three days of life. Low cerebral blood flow has been associated with both intra-ventricular haemorrhage and periventricular leucomalacia. It is well established that cerebral blood flow increases over the first three days of life in extremely preterm infants who are conventionally ventilated with intermittent positive pressure ventilation. However, there is no information about cerebral blood flow in preterm babies undergoing high-frequency oscillatory ventilation. In addition, there are concerns that high-frequency oscillatory ventilation may be associated with an increased incidence of intra-ventricular haemorrhage in premature infants.
Thirteen appropriately grown, preterm infants of less than 28 wk gestation who were admitted to the neonatal unit at University College Hospital, London were studied using near infrared spectroscopy. Left ventricular output and right ventricular output were assessed echocardiographically.
Extremely preterm infants undergoing high-frequency oscillatory ventilation have remarkably low cerebral blood flow in the first 12 h of life, median 6.7 (range 4.4-11) mls. 100 g(-1) min(-1) followed by an increase over the subsequent three days. Left ventricular output also increased over the first three days of life, whereas right ventricular output showed no clear relationship with time. Despite low cerebral blood flow only one infant had evidence of major cerebral injury.
Cerebral blood flow is extremely low in this group of preterm babies. Despite this extremely low cerebral blood flow, the clinical outcome is good. There was an increase in cerebral blood flow and a corresponding increase in left ventricular output over the first few days of life.
采用近红外光谱法测定出生后前三天接受高频振荡通气的极早产儿的脑血流量。脑血流量低与脑室内出血和脑室周围白质软化均有关。众所周知，采用间歇正压通气进行传统通气的极早产儿在出生后的前三天脑血流量会增加。然而，对于接受高频振荡通气的早产儿的脑血流量尚无相关信息。此外，有人担心高频振荡通气可能与早产儿脑室内出血发生率增加有关。
对伦敦大学学院医院新生儿病房收治的13例孕周小于28周、生长发育正常的早产儿，采用近红外光谱法进行研究。通过超声心动图评估左心室输出量和右心室输出量。
接受高频振荡通气的极早产儿在出生后的前12小时脑血流量极低，中位数为6.7（范围4.4 - 11）毫升·100克⁻¹·分钟⁻¹，随后在接下来的三天内有所增加。左心室输出量在出生后的前三天也有所增加，而右心室输出量与时间无明显关系。尽管脑血流量低，但只有一名婴儿有严重脑损伤的迹象。
这组早产儿的脑血流量极低。尽管脑血流量极低，但临床结局良好。在出生后的头几天，脑血流量增加，左心室输出量相应增加。
