【摘要】 通过对早产儿脑血流及平均动脉压变化水平进行监测,了解早产儿的脑血流自主调节功能,探讨受损的脑血流自主调节与脑损伤的关系,对55例早产儿按胎龄分为早产Ⅰ组20例(胎龄<32周)和早产Ⅱ组35例(胎龄>32周)。所有病例均在生后72小时内开始床旁近红外光谱仪(Near-Infrared Spectroscopy,NIRS)及平均动脉压(mean arterial blood pressure,MABP)的监测来判断脑血流自主调节功能;并对所有病例进行头颅B超,随访以判定脑损伤。结果:胎龄<32周20例早产儿中有9例自主调节功能受损(9/20,45％),胎龄≥32周35例早产儿中仅3例自主调节功能受损(3/35,8.6％);有自主调节功能受损者33.3％随后发生严重脑损伤,明显高于自主调节功能良好者,P<0.01。结论:胎龄<32周早产儿易出现脑血流自主调节功能受损,受损的脑血流自主调节与随后严重脑损伤的发生关系密切。更多还原

【Abstract】 In order to find out the functional state of cerebral blood flow autoregulation in the premature infants and determine the relation of the impaired autoregulation to the subsequent occurrence of severe brain injury, 55 premature infants were collected to be assigned to group 1 (gestational age < 32 weeks, 20 cases) and group 2(gestational age≥32 weeks, 35 cases) . During first 3 days of age all patients were monitored by near-infrared spectroscopy (MRS) to determine the changes’ difference (HbD) between cerebral concentration of oxyennated hemoglobin (HbO2) and deoxygenated hemoglobin ( Hb), ie, HbD = ΔHbO2 -ΔHb. MABP measured by arterial pressure transducer. The relationship of MABP to HbD was quantitated by coherence analysis. Cranial ultrasonography was given to every case to diagnosis brain injury. Results showed: Concordant change(coherencescores, r≥0.5) in HbD and MABP, consistent with impaired cerebral blood flow autoregulation, were observed in 9 of 20 infants in group 1 (9/20, 45% ) . Four of the 9 infants developed severe brain injury(grades 3 - 4 GMH-IVH) . In group 2,32 of 35(91.4%) infants were identified with intact autoregulation(coherence scores, r<0.5), none of 35 infants developed severe brain injury. Conculsion: The findings of this study indicated that the impaired cerebrovascular autoregulation is relatively common in the infants of group 1 (gestational age < 32 weeks), and the presence of autoregulation impairment is associated with a high likelihood of occurrence of severe brain injury.更多还原