优化新生儿脑病的血液动力学治疗。

Optimizing hemodynamic care in neonatal encephalopathy.

机构信息

Institute for Women's Health, University College London, London, UK.

Department of Neonatology, University College London Hospital, London, UK.

出版信息

Semin Fetal Neonatal Med. 2020 Oct;25(5):101139. doi: 10.1016/j.siny.2020.101139. Epub 2020 Jul 12.

DOI:10.1016/j.siny.2020.101139

PMID:33223016

Abstract

Hemodynamic impairment occurs in up to 80% of infants with neonatal encephalopathy (NE). Not all infants benefit from therapeutic hypothermia (HT); there are some indications that the trajectory of brain injury might be modified by neurologic monitoring and early management over the first 72-h period. It is also possible that optimizing hemodynamic management may further improve outomes. The coupling between cerebral blood flow and cerebral metabolism is disrupted in NE, increasing the vulnerability of the newborn brain to secondary injury. Hemodynamic monitoring is usually limited to blood pressure and functional echocardiographic measurements, which may not accurately reflect brain perfusion. This review explores the evidence base for hemodynamic assessment and management of infants with NE while undergoing HT. We discuss the literature behind a systematic approach to a baby with NE with the aim to define best therapies to optimize brain perfusion and reduce secondary injury.

摘要

高达 80%的患有新生儿脑病（NE）的婴儿会出现血液动力学障碍。并非所有婴儿都能从治疗性低温（HT）中受益；有一些迹象表明，通过神经监测和最初 72 小时的早期管理，脑损伤的轨迹可能会被改变。优化血液动力学管理也可能进一步改善结果。NE 会破坏脑血流和脑代谢之间的耦合，增加新生儿大脑对二次损伤的易感性。在接受 HT 时，NE 婴儿的血液动力学监测通常仅限于血压和功能性超声心动图测量，这些测量可能无法准确反映脑灌注情况。这篇综述探讨了在 HT 期间对 NE 婴儿进行血液动力学评估和管理的证据基础。我们讨论了 NE 婴儿系统治疗方法背后的文献，旨在确定最佳治疗方法，以优化脑灌注并减少二次损伤。