Levene M I, Fenton A C, Evans D H, Archer L N, Shortland D B, Gibson N A
University Department of Paediatrics and Child Health, General Infirmary of Leeds.
Dev Med Child Neurol. 1989 Aug;31(4):427-34. doi: 10.1111/j.1469-8749.1989.tb04020.x.
Thirty-four fullterm infants with postasphyxial encephalopathy (PAE) were studied with ultrasound to assess cerebral blood-flow velocity (CBFV). A control group of 126 healthy infants also had CBFV recordings during the first week of life. Measurements for the majority of the asphyxiated group fell into two abnormal patterns in relation to the control group: four had low CBFV (less than 2 SD below the mean) and 17 had high CBFV (greater than or equal to 2 SD above the mean); all had severe PAE. Median age at the first high measurement was 26 hours. There were no statistically significant differences between infants with normal and abnormal CBFV in measurements of PaCO2 or mean arterial blood-pressure. A Pourcelot Resistance Index (PRI) less than 0.55 was common in the presence of high CBFV, but never seen with low measurements. 21 of the 34 infants died of their asphyxial insult and four of the survivors have severe cerebral palsy at a median age of two years. Three of the four with low CBFV died, and no infant with CBFV greater than 3 SD survived without severe impairment. The positive predictive value of CBFV measurements less than 2 SD or greater than 3 SD for death or severe impairment is 94 per cent, compared with 83 per cent for low PRI alone. The authors believe that high CBFV is the result of vasoparalysis of cerebral arterioles and that it represents a form of irreversible cerebral injury.
对34名患有窒息后脑病（PAE）的足月儿进行超声检查，以评估脑血流速度（CBFV）。126名健康婴儿组成的对照组在出生后第一周也进行了CBFV记录。与对照组相比，大多数窒息组婴儿的测量结果呈现出两种异常模式：4名婴儿CBFV较低（低于平均值2个标准差），17名婴儿CBFV较高（高于或等于平均值2个标准差）；所有这些婴儿都患有严重的PAE。首次测量到高CBFV时的中位年龄为26小时。CBFV正常和异常的婴儿在动脉血二氧化碳分压（PaCO2）或平均动脉血压测量方面没有统计学上的显著差异。在CBFV较高时，常见的泊肃叶阻力指数（PRI）小于0.55，但在CBFV较低时从未见过。34名婴儿中有21名死于窒息，4名幸存者在两岁时患有严重脑瘫。4名CBFV较低的婴儿中有3名死亡，没有CBFV大于3个标准差的婴儿在没有严重损伤的情况下存活下来。CBFV测量值小于2个标准差或大于3个标准差对死亡或严重损伤的阳性预测值为94%，而单独低PRI的阳性预测值为83%。作者认为，高CBFV是脑小动脉血管麻痹的结果，它代表了一种不可逆的脑损伤形式。
