Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors
Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors
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DOI：
10.1159/000014072
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发表时间：
1999-01-01
期刊：
影响因子：
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通讯作者：
Fanconi, S
中科院分区：
文献类型：
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作者：
Baenziger, O;Moenkhoff, M;Fanconi, S
早期发现与永久性脑损伤相关的病理生理因素是新生儿医学的一个主要问题。本研究的目的是评估脑血流（CBF）的CO2反应性在有围产期危险因素的新生儿中的意义。本前瞻性研究纳入了14例具有围产期危险因素（病理性心脏产程图、低脐带pH值、产后脑病）的机械通气新生儿。研究在出生后18-123小时进行。采用无创性静脉注射法测定CBF。两次测量的最小PaCO 2差值为5 mm Hg。从两个CBF值计算CO2反应性。出生后1年评价结局。较低PaCO 2时的CBF值范围为6.6至115.2 ml/100 g脑组织/min（中位数= 18.2），较高PaCO 2水平时的CBF值范围为7.1至125.7 ml/100 g脑组织/min（中位数18.75）。计算的CO2反应性范围为-9.6至6.6%（中位数1.1%），CBF/mmHg PaCO 2变化。CO2反应性与最低pH值相关（r（2）= 0.35，p = 0.02）。两名婴儿死亡，一名死于新生儿败血症，另一名死于心力衰竭。11例患者1岁时神经功能正常，1例重度脑瘫。在12例存活患者中，严重神经功能缺损患者的CBF值最高（125.7 ml/100 g/min）。有围产期危险因素的新生儿脑血流化学偶联受损与神经系统完整结果一致。这些新生儿的CO2反应性与最低pH值相关，可能反映了围产期窒息的严重程度。
Early detection of pathophysiological factors associated with permanent brain damage is a major issue in neonatal medicine. The aim of our study was to evaluate the significance of the CO2 reactivity of cerebral blood flow (CBF) in neonates with perinatal risk factors. Fourteen ventilated neonates with perinatal risk factors (pathological cardiotocogramm, low cord pH, postpartal encephalopathy) were enrolled into this prospective study. The study was performed 18-123 h after birth. CBF was measured using the nonivasive intravenous Xe-133 method. Two measurements were taken with a minimal PaCO2-difference of 5 mm Hg. From the two CBF values the CO2 reactivity was calculated. Outcome was evaluated 1 year after birth. The CBF values at a lower PaCO2 ranged from 6.6 to 115.2 ml/100 g brain tissue/min (median = 18.2) and at a higher PaCO2 level from 7.1 to 125.7 ml/100 g brain tissue/min (median 18.75). The calculated CO2 reactivity ranged from -9.6 to 6.6% (median 1.1%) change in CBF/mm Hg change in PaCO2. CO2 reactivity correlated with lowest pH (r(2) = 0.35, p = 0.02). Two infants died, one of neonatal sepsis, the other of heart failure. Neurological outcome at the age of 1 year was normal in 11 patients, 1 had severe cerebral palsy. From the 12 surviving patients the patient with severe neurological deficit showed the highest CBF values (125.7 ml/100 g/min). Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors. CO2 reactivity in these newborns correlates with the lowest pH and may reflect the severity of perinatal asphyxia.