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目的了解窒息新生儿在听觉刺激诱发脑神经活动时的脑氧合代谢和脑血流量的改变。方法1998~2003年北京中日友好医院儿科选择窒息新生儿34例为窒息组,健康新生儿40名为对照组。使用近红外光谱仪,观察听觉刺激试验诱发的脑氧合血红蛋白[HbO2]、还原血红蛋白[HbH]和总血红蛋白[Hbtot]浓度的变化,并比较两组脑氧合代谢和脑血流量的改变。根据[HbO2]、[HbH]和[Hbtot]不同的变化,将氧合代谢曲线分为A([HbO2]、[HbH]和[Hbtot]均增加);B([HbO2]和[Hbtot]增加,[HbH]降低);C([HbO2]和[Hbtot]降低,[HbH]增加)3种曲线类型。结果窒息组中25例(25/34、73·5%)显示C型变化,对照组中28例(28/40、70·0%)显示A型变化,两组中A、C两型例数比较差异显著(P<0·05)。两组[HbO2]和[Hbtot]数值变化幅度比较差异显著(P<0·05)。结论窒息新生儿听觉刺激诱发相应皮层的神经活动时,显示局部脑血流量下降、氧合代谢降低,重度窒息儿更明显。
Objective To investigate the changes of cerebral oxygenation metabolism and cerebral blood flow in asphyxiated neonates during auditory stimulation-induced cranial nerve activity. Methods From 1998 to 2003, 34 neonates with asphyxia in pediatric department of Beijing Sino-Japanese Friendship Hospital in Beijing were asphyxiating group and 40 healthy neonates as control group. The changes of cerebral hemoglobin [HbO2], reduced hemoglobin [HbH] and total hemoglobin [Hbtot] induced by auditory stimulation test were observed using near infrared spectroscopy. The changes of cerebral oxygenation metabolism and cerebral blood flow were compared between the two groups. The oxygenation metabolic profile was divided into A ([HbO2], [HbH], and [Hbtot] increased) according to different changes of [HbO2], [HbH] and [Hbtot]; B ([HbO2] and [Hbtot] , [HbH] decreased); C ([HbO2] and [Hbtot] decreased, [HbH] increased). Results 25 cases (25/34, 73.5%) in asphyxia group showed the change of type C, and 28 cases (28.0%, 70.0%) in control group showed type A change. The two groups of type A and C The difference was significant (P <0.05). There was significant difference between the two groups [HbO2] and [Hbtot] (P <0.05). Conclusions Asphyxial neonatal hearing stimulation can induce neuronal activity in the corresponding cortex, which shows that the local cerebral blood flow decreases, the oxygenation metabolism decreases, and the severe asphyxia is more obvious.