VASOPARALYSIS ASSOCIATED WITH BRAIN-DAMAGE IN ASPHYXIATED TERM INFANTS
VASOPARALYSIS ASSOCIATED WITH BRAIN-DAMAGE IN ASPHYXIATED TERM INFANTS
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DOI：
10.1016/s0022-3476(05)72459-8
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发表时间：
1990-07-01
影响因子：
5.1
通讯作者：
FRIISHANSEN, B
中科院分区：
文献类型：
--
作者：
PRYDS, O;GREISEN, G;FRIISHANSEN, B
本文测定了19例重度窒息足月新生儿机械通气后第1天脑血流量与动脉血二氧化碳分压和平均动脉压(MABP)的关系。作为对比，12名无围产期窒息的婴儿也被调查了。全球脑血流量(CBF.infin.)在大约2小时内被氙气133清除两到三次。在脑血流量测量过程中，记录幅度积分脑电和视觉诱发电位。随着呼吸机设置的调整，动脉二氧化碳分压发生变化，而平均动脉压则自发波动。动脉血氧分压和血糖浓度均在正常范围。其中五名窒息婴儿做了等电脑图检查，随后死于严重的脑损伤。他们有很高的CBF.inin。(平均30.6毫升/100克/分钟)，并消除二氧化碳和MABP的反应性。降低CBF.infin。另5例有猝发抑制脑电图的窒息婴儿出现脑部CT或临床体征，发现MABP反应性丧失(平均14.7ml/100gm/min)。这些婴儿体内保存的二氧化碳反应性。在其余9名没有中枢神经系统异常迹象的窒息婴儿中，二氧化碳和MABP反应性被保留下来，就像对照组一样。我们的结论是，自我调节功能的丧失与窒息婴儿的脑损伤有关，等电脑电和脑过度融合的组合是非常严重的脑损伤的早期指标。
The relationship of cerebral blood flow to acute changes in arterial carbon dioxide and mean arterial blood pressure (MABP) was determined during the first day of life in 19 severely asphyxiated term infants supported by mechanical ventilation. For comparison, 12 infants without perinatal asphyxia were also investigated. Global cerebral blood flow (CBF.infin.) was determined by xenon 133 clearance two or three times within approximately 2 hours. During the cerebral blood flow measurement, the amplitude-integrated electroencephalogram and visual-evoked potential were recorded. Changes in arterial carbon dioxide pressure followed adjustments of the ventilator settings, whereas MABP fluctuated spontaneously. Arterial oxygen pressure and blood glucose concentration were in the normal range. Five of the asphyxiated infants had isoelectric electroencephalograms and died subsequently with severe brain damage. They had a high CBF.infin. (mean 30.6 ml/100 g/min) and abolished carbon dioxide and MABP reactivity. Lower CBF.infin. (mean 14.7 ml/100 gm/min) and abolished MABP reactivity were found in another five asphyxiated infants with burst-suppression electroencephalograms in whom computed tomographic or clinical signs of brain lesions developed. The carbon dioxide reactivity as preserved in these infants. In the remaining nine asphyxiated infants without signs of central nervous system abnormality, carbon dioxide and MABP reactivity were preserved, as was also the case in the control group. We conclude that abolished autoregulation is associated with cerebral damage in asphyxiated infants and that the combination of isoelectric electroencephalograms and cerebral hyperfusions is an early indicator of very severe brain damage.