脑血流动力学参数联合动脉血气分析早期识别早产儿脑损伤的临床价值

Clinical value of cerebral hemodynamic parameters combined with arterial blood gas analysis in early identification of brain injury in premature infants

摘要:

目的 探讨脑血流动力学参数联合动脉血气分析早期识别早产儿脑损伤的临床价值。方法 选取2019年8月—2022年8月三亚中心医院确诊的96例脑损伤早产儿作为病例组，另外选取同期出生且未发生脑损伤的100例早产儿作为对照组。对比两组产后第1天的动脉血气指标、大脑中动脉血流参数，并根据病情程度将病例组分为轻度组、中重度组进行分层对比；分析上述指标与脑损伤患儿的改良Sarnat评分的相关性。结果 病例组pH、PaO₂、BE低于对照组，乳酸、PCO₂高于对照组（P <0.05）。病例组MCA的Vd、Vs、RI、S/D较对照组高（P <0.05）。轻度组pH、PaO₂、BE高于中重度组，轻度组乳酸、PCO₂低于中重度组（P <0.05）。轻度组MCA的Vd、Vs、RI、S/D低于中重度组（P <0.05）。脑损伤新生儿的Sarnat评分与pH、PaO₂、BE呈负相关（r =-0.671、-0.612和-0.495，均P <0.05），与乳酸、PCO₂呈正相关（r =0.486和0.433，均P <0.05）。Sarnat评分与MCA的Vd、Vs、RI、S/D测定值呈正相关（r =0.664、0.598、0.639和0.670，均P <0.05）。结论 脑损伤早产儿在出生30 min内检测脑动脉血流及动脉血气指标即可发现显著异常，并且与患儿脑损伤程度有关。

Abstract:

Objective To investigate the clinical value of cerebral hemodynamic parameters combined with arterial blood gas indicators in early identification of brain injury in premature infants.Methods Ninety-six premature infants with brain injury diagnosed in Sanya Central Hospital from August 2019 to August 2022 were selected as the case group, and 100 premature infants born during the same period without brain injury were selected as the control group. The arterial blood gas indicators and hemodynamic parameters of the middle cerebral artery on the first day after birth were compared between the two groups of premature infants, and those in the case group were further divided into the mild group and the moderate to severe group according to the severity for subgroup analysis. The correlation between the above indicators and the modified Sarnat score in premature infants with brain injury was analyzed.Results As indicated in the arterial blood gas analysis, the pH value, partial pressure of oxygen (PaO₂) and base excess (BE) in the case group were lower than those in the control group (P < 0.05), and the level of lactic acid and partial pressure of carbon dioxide (PCO₂) in the case group were higher than those in the control group (P < 0.05). The Vd, Vs, RI and S/D of the middle cerebral artery in the case group were higher than those in the control group (P < 0.05). The pH value, PaO₂ and BE in the mild group were higher than those in the moderate to severe group (P < 0.05), and the level of lactic acid and PCO₂ in the mild group were lower than those in the moderate to severe group (P < 0.05). The Vd, Vs, RI and S/D of middle cerebral artery in the mild group were lower than those in the moderate to severe group (P < 0.05). The Sarnat score of infants with brain injury was negatively correlated with pH value (r = -0.671), PaO₂ (r = -0.612) and BE (r = -0.495) (P < 0.05), while the level of lactic acid and PCO₂ were positively correlated with the Sarnat score (r = 0.486 and 0.433, both P < 0.05). Besides, the Sarnat score was positively correlated with Vd (r = 0.664), Vs (r = 0.598), RI (r = 0.639) and S/D (r = 0.670) of middle cerebral artery (P < 0.05).Conclusions In preterm infants with brain injury, significant abnormalities can be found by detecting cerebral blood flow and arterial blood gas indicators on the first day after birth, and they are associated with the severity of brain injury.