Perlman J M, McMenamin J B, Volpe J J
N Engl J Med. 1983 Jul 28;309(4):204-9. doi: 10.1056/NEJM198307283090402.
We studied whether changes in cerebral blood-flow velocity occur during the respiratory-distress syndrome and whether, if present, they are related to the subsequent occurrence of intraventricular hemorrhage. Fifty infants weighing less than 1500 g at birth who required mechanical ventilation for the respiratory-distress syndrome were studied from the first hours of life. Blood-flow velocity in the anterior cerebral artery was measured at the anterior fontanel by means of the Doppler technique. At 12 hours of age, the infants had blood-flow velocity patterns that were either stable or fluctuating and that reflected the patterns of simultaneously recorded blood pressure. Intraventricular hemorrhage subsequently developed in 21 of 23 infants with the fluctuating pattern (in most of them, within the next 24 hours), but in only 7 of 27 infants with the stable pattern. Preliminary data suggest that the cerebral hemodynamic fluctuations are related to the respiratory disease and particularly to the mechanics of respiration. We conclude that the fluctuating pattern of cerebral blood-flow velocity in infants with the respiratory-distress syndrome indicates an extreme risk of the development of intraventricular hemorrhage and may represent a major and potentially preventable etiologic factor.
我们研究了呼吸窘迫综合征期间脑血流速度是否发生变化，以及如果存在变化，它们是否与随后发生的脑室内出血有关。对50名出生时体重不足1500g且因呼吸窘迫综合征需要机械通气的婴儿从出生后的最初几个小时开始进行研究。通过多普勒技术在前囟门处测量大脑前动脉的血流速度。在12小时龄时，婴儿的血流速度模式要么稳定要么波动，且反映了同时记录的血压模式。随后，23名血流速度模式波动的婴儿中有21名发生了脑室内出血（其中大多数在接下来的24小时内），但27名血流速度模式稳定的婴儿中只有7名发生了脑室内出血。初步数据表明，脑血流动力学波动与呼吸系统疾病有关，尤其是与呼吸力学有关。我们得出结论，呼吸窘迫综合征婴儿脑血流速度的波动模式表明发生脑室内出血的风险极高，可能是一个主要的且有可能预防的病因。
