新生儿缺氧缺血性脑病脑血流动力学变化与血浆内皮素-1、一氧化氮的关系

• 作 者: 万致婷 陈瑾
• 机 构: 湖北省咸宁市中心医院儿科,湖北省咸宁市中心医院儿科,湖北省咸宁市中心医院儿科,湖北省咸宁市中心医院儿科,湖北省咸宁市中心医院TCD室,湖北省咸宁医学院,湖北省咸宁医学院,华中科技大学同济医院核医学科
• 出 处: 实用儿科临床杂志
• 发表日期: 2002年03期
• 关键词: 脑血流动力学 脑缺氧 大脑动脉 脑缺血 中度组 舒张末期流速 脑血流变化 硝酸还原酶法 血浆内皮素 搏动指数

目的　探讨一氧化氮 (NO)、内皮素 1 (ET 1 )在新生儿缺氧缺血性脑病 (HIE)脑血流动力学变化中的作用。方法　HIE各组均在生后 48～ 72h采用经颅多谱勒超声 (TCD)检测双侧大脑前、中、后动脉收缩峰流速 (Vs)、舒张末期流速 (Vd)、搏动指数 (PI)和阻力指数 (RI) ,同时用硝酸还原酶法和放射免疫法分别测定血浆NO和ET 1水平。对照组同期进行上述检测。结果　 1 .脑血流于轻度组Vd、Vs局部降低 ;中、重度组Vd广泛降低 ,Vs呈局部降低 ,重度组尤为显著 (P均 <0 .0 5)。 2 .PI、RI轻度组与对照组无显著性差异 ;中度组局部增高 ;重度组双侧大脑动脉PI、RI普遍增高 (P均 <0 .0 5)。 3 .HIE各组NO、ET 1水平均高于对照组 ,且与病变程度成正比。但NO/ET 1比值低于对照组 (P均 <0 .0 1 ) ,且重度组 <中度组 <轻度组。结论　HIE患儿脑血流灌注减少与NO、ET 1过量合成、功能失调有关。 Objective To investigate the effects of nitric oxide (NO) and endothelin 1 (ET 1) on cerebral hemodynamics in neonates with hypoxic-ischemic encephalopathy (HIE). Methods The peak systolic velocity (Vs), end-diastolic velocity (Vd), pulsatility index (PI) of bilateral frontal, middle and posterior arteries were measured by transcranial Doppler sonography (TCD) And resistance index (RI). Plasma NO and ET 1 levels were measured by nitrate reductase and radioimmunoassay, respectively. The control group conducted the same test over the same period. Results 1. The cerebral blood flow in the mild group Vd, Vs decreased locally; moderate and severe group Vd decreased broadly, Vs showed a local decrease, especially severe group (P all <0.05). There was no significant difference between PI and RI mild group and control group; the moderate group increased locally; PI and RI of bilateral cerebral artery in severe group were generally higher (P <0.05). The levels of NO and ET 1 in HIE groups were all higher than those in control group, and were proportional to the degree of lesions. But the NO / ET 1 ratio was lower than that of the control group (all P <0.01), and the severe group