【摘要】 目的探讨新生儿缺氧缺血性脑损伤(hypoxic-ischemicbraindamage,HIBD)选择性头部亚低温治疗期间脑血流和脑氧合代谢的变化。方法38例中、重度HIBD新生儿随机分为常温组和低温组;7例相对正常的新生儿作为对照组。生后6h以内开始治疗,常温组维持体温在36℃,低温组维持鼻咽温度在34℃,低温持续72h,然后自然复温,其它治疗方法两组相同。三组均持续观察84h。三组患儿分别在生后6、12、24、48、72和84h,采用经颅多普勒血流诊断仪测定大脑中动脉的血流速率的变化,采用近红外光谱分析技术测定细胞色素aa3(cytochromeaa3,Cytaa3)的变化。结果低温组新生儿生后6h内收缩期血流速率(Vs)[(250．5±7．69)cm／s],平均血流速率(Vs)[(15．67±5．97)cm／s]、舒张末期血流速率(Vd)[(7．27±5．06)cm／s]和△Cytaa3均较对照组降低,阻力指数(RI)(0．81±0．15)较对照组(0．67±0．09)增加(P均<0．05);低温组Vs和Vm在生后12-48h较常温组增加(P均<0．05),RI降低(P<0．05),且与对照组无差别。与常温组比较,低温组△Cytaa3在生后36-60h显著增加(P<0．05或0．01)。结论中重度新生儿HIBD脑血速率明显降低,存在明显的脑氧合障碍;选择性头部亚低温治疗新生儿HIBD可以改善脑血流动力学和脑氧合代谢状态。更多还原

【Abstract】 Objective To study the changes of cerebral blood flow and cerebral oxygenation during selective head cooling (SHC) in neonates with hypoxic-ischemic brain damage (HIBD). Methods Thirty-eight neonates with moderate and severe HIBD were enrolled in two groups: SHC group (n=18) and normal temperature group (n=20). The gestational age of all subjects were more than 38 weeks and Apgar score in 5 minutes after birth was less than 5 scores. Also, nerve system symptoms and electroencephalogram abnormal was found in 6 hours after birth. Neonates in SHC group had nasopharyngeal temperature maintained 34℃ and in normal trmerature guoup had rectum temperature maintained about 36℃. Seven healthy neonates were as control group. Three groups were observed 84 h. Cerebral blood flow velocity (CBFV) of middle cerebral artery (MCA) was measured with transcranial Doppler (TCD) at 6, 12, 24, 48, 72 and 84 hours after birth. Cerebral cytochrome aa3 (Cytaa3 ) was monitored continuously throughout the study using near infrared spectroscopy (NIRS). Results At 6th hours after birth, Vs [(25. 05±7. 69)cm/s]、Vd [(7. 22±3. 01) cm/s] and Vm [(15. 61±5. 97) cm/s] of MCA and △Cytaa3 in SHC group were lower, and RI (0. 81±0. 15) was higher than control group (P<0. 05). At 12-48 h, Vs、Vm in SHC group were higher and RI were lower compared with normal temperature group (P<0. 05). At 36 - 60 hours, △Cytaa3 in SHC group was lower than normal temperature group(P<0. 05 or 0. 01). Conclusions Neonate hypoxic-ischemic hypothermia near infrared spectroscopy cerebral blood flow oxygenation metabolism.更多还原