Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (3): 287-291    DOI: 10.3785/j.issn.1008-9292.2016.05.10
原著     
血流动力学改变对动脉导管未闭早产儿脑白质损伤发生的影响
陆俊秀1, 杨冰岩1, 陈敬国2, 徐焕丽3, 陈海燕2
1. 南方医科大学附属中山市博爱医院新生儿科, 广东 中山 528400;
2. 中山大学附属中山医院新生儿科, 广东 中山 528403;
3. 深圳市儿童医院新生儿科, 广东 深圳 518000
Effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus
LU Junxiu1, YANG Bingyan1, CHEN Jingguo2, XU Huanli3, CHEN Haiyan2
1. Department of Neonate, BOAI Hospital of Zhongshan Affiliated to Southern Medical University, Zhonshan 528400, China;
2. Department of Neonate, Zhongshan People's Hospital Affiliated to Sun Yat-sen University, Zhonshan 528403, China;
3. Department of Neonate, Shenzhen Children's Hospital, Shenzhen 518000, China
全文: PDF(1034 KB)  
摘要: 

目的：探讨血流动力学改变对动脉导管未闭（PDA）早产儿脑白质损伤发生的影响。方法：具有血流动力学改变的PDA早产儿35例（hsPDA组）、没有血流动力学改变的PDA早产儿35例（非hsPDA组）、非PDA早产儿36例（对照组）分别于出生后3 d、7 d、14 d检测血清神经特异性烯醇化酶（NSE）的水平，同时进行颅脑超声显像检查，作超声心动图显像PDA血流速度与颅脑超声显像侧脑室灰度值相关性分析。结果：出生后3 d、7 d、14 d颅脑超声显像侧脑室灰度值hsPDA组均高于对照组（均P<0.01），非hsPDA组与对照组差异均无统计学意义（均P>0.05）；出生后3 d、7 d、14 d血清NSE水平hsPDA组均高于对照组（均P<0.01），非hsPDA组与对照组差异均无统计学意义（均P>0.05）。早产儿PDA血流速度大小与超声显像侧脑室灰度值呈正相关（r=0.876，P<0.01）。结论：hsPDA早产儿容易发生脑白质损伤，需要及时干预。
关键词 ： 血流动力学,  动脉导管未闭/病理生理学,  磷酸丙酮酸水合酶/血液,  神经元/酶学,  白质软化病,脑室周围/病理学,  脑损伤/病理学,  婴儿,早产    
Abstract：

Objective: To investigate the effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus(PDA). Methods: A total of 106 premature infants were enrolled in the study, including 35 PDA infants with hemodynamic changes (hsPDA group), 35 PDA infants without hemodynamic changes (non-hsPDA group) and 36 non-PDA infants (control group). Serum level of neuron-specific enolase (NES) was detected and craniocerebral ultrasound examination was performed on d3, d7 and d14 after birth. The correlation between blood flow rate of PDA and gray scale value of lateral ventricle was analyzed. Results: Gray scale values of lateral ventricle and serum levels of NES in hsPDA group were higher than those in control group on d3, d7 and d14 (P<0.01), but no significant difference was observed between non-hsPDA group and control group (P>0.05). There was a positive correlation between the blood flow rate of PDA and gray scale value of lateral ventricle (r=0.876, P<0.01) in premature infants. Conclusion: Patent ductus arteriosus with hemodynamic changes is closely related to white matter damage in premature infants, and early intervention is necessary.
Key words： Hemodynamics    Ductus arteriosus, patent/physiopathology    Phosphopyruvate hydratase/blood    Neurons/enzymology    Leukomalacia, periventricular/pathology    Brain injuries/pathology    Infant, premature
收稿日期: 2016-01-15
CLC:  R4  
基金资助:

2013年中山市医学科研项目（2013a020050）
通讯作者: 杨冰岩(1963-),男,学士,主任医师,主要从事新生儿及小儿急救研究;E-mail:ybyicu@126.com;http://orcid.orgorcid.org/0000-0002-6022-6605     E-mail: ybyicu@126.com
作者简介: 陆俊秀(1983-),女,硕士研究生,主治医师,主要从事新生儿神经系统疾病研究;E-mail:lujunxiu2011@163.com;http://orcid.org/0000-0001-6591-6982
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　

引用本文:

陆俊秀 等. 血流动力学改变对动脉导管未闭早产儿脑白质损伤发生的影响[J]. 浙江大学学报（医学版）, 2016, 45(3): 287-291.
LU Junxiu, YANG Bingyan, CHEN Jingguo, XU Huanli, CHEN Haiyan. Effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus. Journal of ZheJiang University(Medical Science), 2016, 45(3): 287-291.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.05.10      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I3/287

[1] HEO M J, LEE O S, LIM S C. Comparative evaluation for the use of oral ibuprofen and intravenous indomethacin in Korean infants with patent ductus[J]. Arch Pharm Res, 2012, 35(9):1673-1683.
[2] RICHARDS J, JOHNSON A, FOX G, et al. A second course of ibuprofen is effective in the closure of a clinically significant PDA in ELBW infants[J/OL]. Pediatrics, 2009, 124(2): e287-e293.
[3] KOCH J, HENSLEY G, ROY L, et al. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 gramsor less[J]. Pediatrics, 2006, 117(4): 1113-1121.
[4] SOUL J S, ROBERTSON R L, WYPIJD C, et al. Subtle hemorrhagic brain injury is associated with neuro developmental impairment in infants with repaired congenital heart disease[J]. J Thorac Cardiovasc Surg, 2009, 138(2): 374-381.
[5] 冯琪,李源,王颖,等.早产儿动脉导管未闭的临床研究[J].实用儿科临床杂志,2005, (2): 129-131. FENG Qi, LI Yuan, WANG Ying, et al. Clinical investigation on patent ductus arteriosus of premature infants.[J].Journal of Applied Clinical Pediatrics,2005, (2): 129-131. (in Chinese)
[6] VAN WEZEI-MEIJLER G, STEGGERDA S J, LEIJSER L M.Cranial ultrasonography in neonates:role and limitations[J].Semin Perinatol,2010,34(1):28-38.
[7] 周丛乐,汤泽中. 三维超声在新生儿颅脑疾病诊断中的价值[J]. 临床儿科杂志,2006,24(11): 863-865. ZHOU Congle,TANG Zezhong. Diagnostic value of three-dimensional ultrasoundral in neonatal cerebral disorders[J]. Journal of Clinical Pediatrics, 2006, 24(11): 863-865.(in Chinese)
[8] DAVAL J L,POURIE G,GROJEAN S,et al. Neonatal hypoxia triggers transient apoptosis followed by neurogenesis in the rat CA1 hippocampus[J]. Pediatr Res, 2004, 55(4):561-567.
[9] 陆俊秀,陈敬国,陈海燕,等. 颅脑超声与血清NSE对早产儿脑白质损伤的诊断价值及二者相关性分析[ J ]. 临床儿科杂志, 2012, 30(9):836-839. LU Junxiu,CHEN Jingguo,CHEN Haiyan,et al. Diagnostic value and correlation analysis of ultrasound and neuron-specific enolase in premature infant with white matter damage[J]. Journal of Clinical Pediatrics, 2012, 30(9): 840-844. (in Chinese)
[10] SKINNER J. Diagnosis of patent ductu sarteriosus[J]. Semin Neonatol, 2001, 6(1): 49-61.
[11] LINS H,WALLESCH C W,WUNDERLICH M T.Sequential analyses of neurobiochemical markers of cerebral damage in cerebrospinal fluid and serum in CNS infections[J].Acta Neurol Scand, 2005, 112(5): 303-308.
[12] BROUWER M J,DE VRIES L S, PISTORIUS L,et al. Ultrasound measurements of the lateral ventricles in neonates:why,how and when? A systematic review[J]. Acta Paediatr, 2010,99(9): 1298-1306.
[13] DE VRIES L S,GROENENDAAL F.Patterns of neonatal hypoxic-ischaemic brain injury[J].Neuroradiology, 2010, 52(6):555-566.
[1] 陆小慧, 谢广平, 顾新华, 卢东民. 咬合重建修复对咬合关系丧失患者脑血流和血氧饱和度的影响[J]. 浙江大学学报（医学版）, 2015, 44(1): 90-94.
[2] 陈伟莉，等. 动态CT血管造影评估急性缺血性卒中患者侧支血流与静脉溶栓预后的关系[J]. 浙江大学学报（医学版）, 2014, 43(1): 14-19.
[3] . 复方樟柳碱治疗原发性开角型青光眼疗效的临床研究[J]. 浙江大学学报（医学版）, 2012, 40(6): 659-662.
[4] . 复方樟柳碱治疗原发性开角型青光眼疗效的临床研究[J]. 浙江大学学报（医学版）, 2011, 40(6): 659-662.
[5] 杨树龙，夏强，沈岳良，周苏娅. κ-阿片和肾上腺素受体激动在缺血再灌注心脏中的交互作用[J]. 浙江大学学报（医学版）, 2003, 32(3): 187-191.
[6] 蒋国平, 康曼丽, 何瑾, 夏呈森, 朱卫华. 超声测量主动脉血流动力学参数对动脉导管未闭的诊断价值[J]. 浙江大学学报（医学版）, 1998, 27(6): 259-260,280.