Wigglesworth J S, Pape K E
Early Hum Dev. 1978 Jul;2(2):179-99. doi: 10.1016/0378-3782(78)90010-5.
The vascular anatomy of the developing brain changes from a predominantly basal ganglia orientated pattern at 24 wk to a cortically orientated pattern by 34 wk. This information, combined with other known data on cerebral vascular anatomy and physiology, allows us to develop a model for haemorrhagic and ischaemic lesions in the newborn brain based on two main series of reactions. One series involves the effects of hypoxia and hypercapnia in leading to breakdown of the blood--brain barrier with resultant oedema or haemorrhage. The other links a fall in perfusion pressure and factors causing vasoconstriction with the development of ischaemic lesions. Application of the model involves additional consideration of the state of development of the cerebral vessels at the gestational age concerned. The model helps to explain the observed findings in germinal layer haemorrhage/intraventricular haemorrhage, periventricular leukomalacia and venous infarction, in the preterm brain. Its use also suggests that there are three patterns of vulnerability in the term infant brain. The model carries several implications for the neonatal management of preterm infants. Routine continuous monitoring of blood pressure is of critical importance as cerebral blood flow may vary with blood pressure in the ill newborn. It is important to avoid head compression which may lead to impaired cerebral perfusion. Finally, control of the acid--base status is essential for maintenance of the blood--brain barrier. Correction of abnormal values must be carried out without provoking rapid swings in either the serum osmolarity or the blood pressure.
发育中大脑的血管解剖结构从孕24周时以基底神经节为主的模式，转变为孕34周时以皮质为主的模式。这一信息，结合关于脑血管解剖和生理学的其他已知数据，使我们能够基于两个主要反应系列建立一个新生儿脑内出血和缺血性病变的模型。一个系列涉及缺氧和高碳酸血症导致血脑屏障破坏，继而引发水肿或出血的影响。另一个系列将灌注压下降和导致血管收缩的因素与缺血性病变的发展联系起来。该模型的应用还需要额外考虑相关孕周时脑血管的发育状态。该模型有助于解释早产儿脑生发层出血/脑室内出血、脑室周围白质软化和静脉梗死的观察结果。它的应用还表明足月儿脑存在三种易损模式。该模型对早产儿的新生儿管理有几个启示。常规持续监测血压至关重要，因为患病新生儿的脑血流可能随血压变化。避免头部受压很重要，因为这可能导致脑灌注受损。最后，控制酸碱状态对于维持血脑屏障至关重要。必须在不引起血清渗透压或血压快速波动的情况下纠正异常值。
