Julkunen Mia, Parviainen Tiina, Janas Martti, Tammela Outi
Pediatric Research Centre, University of Tampere, Tampere, Finland.
Ultrasound Med Biol. 2008 Apr;34(4):538-45. doi: 10.1016/j.ultrasmedbio.2007.10.012. Epub 2007 Dec 21.
We investigated the association of intracranial arterial end-diastolic block with mean arterial pressure (MAP), patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) in infants with birth weights <1000 g. End-diastolic block was diagnosed when end-diastolic flow was found to be absent from the Doppler waveforms in cerebral arteries by pulsed Doppler ultrasound examinations. Cranial ultrasonography and pulsed Doppler examination of anterior cerebral and basilar arteries were performed in 55 preterm infants (gestational age range 24-31 wk) one to four times during the first four days of life. Of these, 22 (40%) developed an end-diastolic block at least once (block group); in 33 no block was detected (control group). Echocardiography was performed and MAP recorded concomitantly. The block group infants had significantly lower mean MAPs than the controls and 59% of those had MAP of 30 mm Hg or lower. In the block group, IVH developed more often in infants with MAP <30 mm Hg (46%) than in infants with MAPs >30 mm Hg (0%). However, in the control group IVH developed equally frequently in infants with MAP < or =30 mm Hg (33%) and in infants with MAP >30 mm Hg (30%). PDA was a significant risk factor for IVH. An end-diastolic block in the cerebral circulation, together with a MAP of < or =30 mm Hg or less and the presence of PDA during the first four days of life, might be associated with IVH in extremely-low-birth-weight infants.
我们研究了出生体重<1000g的婴儿颅内动脉舒张末期血流阻滞与平均动脉压（MAP）、动脉导管未闭（PDA）及脑室内出血（IVH）之间的关联。通过脉冲多普勒超声检查，当发现脑动脉多普勒波形中舒张末期血流缺失时，即可诊断为舒张末期血流阻滞。在55例早产儿（胎龄范围24 - 31周）出生后的头四天内，对其进行了一至四次头颅超声检查以及大脑前动脉和基底动脉的脉冲多普勒检查。其中，22例（40%）至少有一次出现舒张末期血流阻滞（阻滞组）；33例未检测到血流阻滞（对照组）。同时进行了超声心动图检查并记录了MAP。阻滞组婴儿的平均MAP显著低于对照组，其中59%的婴儿MAP≤30mmHg。在阻滞组中，MAP<30mmHg的婴儿发生IVH的频率（46%）高于MAP>30mmHg的婴儿（0%）。然而，在对照组中，MAP≤30mmHg的婴儿（33%）和MAP>30mmHg的婴儿（30%）发生IVH的频率相同。PDA是IVH的一个重要危险因素。在极低出生体重儿出生后的头四天内，脑循环中的舒张末期血流阻滞，以及MAP≤30mmHg或更低，再加上存在PDA，可能与IVH有关。
