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目的探讨心肺复苏后患儿脑血流变化特点及与预后的关系。方法经颅多普勒超声动态监测心肺复苏后的患儿45例,以左侧大脑中动脉和颈内动脉颅外段为靶血管,观察频谱形态和血流速度,同时做Glasgow昏迷评分。根据经颅多普勒超声频谱形态将患儿分为低灌流组、高灌流组和大致正常组。结果低灌流组和高灌流组最高G1asgow评分明显低于大致正常组(P<0.01);而因深昏迷放弃治疗和死亡数明显高于大致正常组(P<0.01)。低灌流组随病程进展脑血流无明显改善;高灌流组2例随病情加重转变为低灌流型:存活患儿随病情好转经颅多普勒超声频谱逐渐趋于正常。结论经颅多普勒超声监测心肺复苏后患儿脑血流变化有助于了解脑灌流状况,评估预后,并指导临床治疗。
Objective To investigate the characteristics of cerebral blood flow in children after cardiopulmonary resuscitation and its relationship with prognosis. Methods Totally 45 children with cardiopulmonary resuscitation were monitored by transcranial Doppler echocardiography. The left middle cerebral artery and internal carotid artery extracranial segments were selected as the target vessel. Spectral morphology and blood flow velocity were observed. At the same time, Glasgow Coma Scale was used. According to transcranial Doppler ultrasound spectrum, the children were divided into low perfusion group, high perfusion group and normal group. Results The highest G1asgow score was significantly lower in the low-perfusion group and the high-perfusion group than in the normal group (P <0.01). The treatment and death due to deep coma abandonment were significantly higher than those in the normal group (P <0.01). In the low perfusion group, the cerebral blood flow was not significantly improved with the progression of the disease. In the hyperperfusion group, 2 patients turned to hypoperfusion with the aggravation of disease. The transcranial Doppler ultrasonography gradually became normal with the improvement of the patient’s condition. Conclusion Transcranial Doppler ultrasound monitoring of cerebral blood flow changes in children after cardiopulmonary resuscitation help to understand the cerebral perfusion, prognosis, and guide clinical treatment.