收稿日期: 2023-05-06
网络出版日期: 2023-09-26
基金资助
江苏省卫生健康委员会妇幼健康科研项目(F201858);江苏省卫生健康委员会第三周期省妇幼健康重点人才项目(SWBFY 2021-9);扬州市“十三五”科教强卫工程重点实验室项目(YWKJ2018-2)
The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants
Received date: 2023-05-06
Online published: 2023-09-26
目的 评价血压变异性（BPV）、大脑前动脉（ACA）血流参数在胎龄≤ 32周、出生体质量≤ 1 500 g早产儿脑室内出血（IVH）中的预测价值。 方法 选择新生儿重症监护室（NICU）收治的胎龄≤ 32周、出生体质量≤ 1 500 g的早产儿为研究对象。所有早产儿生后1 h内入院，每间隔1 h监测收缩压（SBP）、舒张压（DBP）和平均动脉压（MABP），采用最大值与最小值之差（max - min）、标准差（SD）、变异系数（CV）、连续变异系数（SV）作为BPV指标，入院第1、3、7天行头颅彩超检查，筛查IVH的发生，第1天同时测量ACA的收缩期峰流速率（Vs）、舒张末期血流速度（Vd）和阻力指数（RI）。依据头颅彩超检查结果将早产儿分为IVH组和非IVH组，分析BPV指标、ACA血流参数与IVH发生的关系。 结果 共92例早产儿符合纳入标准，其中IVH组49例，非IVH组43例。两组早产儿的胎龄、出生体重、性别、围产期病史等基线特征差异无统计学意义（P > 0.05）。SBP SD（OR = 1.480，95% CI：1.020 ~ 2.147）和ACA-RI（OR = 3.027，95%CI：2.769 ~ 3.591）是早产儿发生IVH 的独立危险因素，联合检测SBP SD和ACA-RI预测IVH的敏感度为61.2%，特异度为79.1%。 结论 高BPV和ACA-RI与胎龄≤ 32周、出生体重≤ 1 500 g早产儿IVH发生相关，联合SBP SD、SBP CV和ACA-RI检测对于IVH的早期识别有一定的预测作用。
蒋丽军 , 于倩 , 王伏东 , 吴明赴 , 刘志峰 , 张龙峰 , 张利兵 . 血压变异性联合脑血流参数在预测极低出生体重早产儿脑室内出血的作用[J]. 实用医学杂志, 2023 , 39(16) : 2116 -2121 . DOI: 10.3969/j.issn.1006-5725.2023.16.018
Objective Hemodynamic instability is the main factor in the development of intraventricular hemorrhage （IVH） in preterm infants. The purpose of this study is to evaluate the predictive value of blood pressure variability （BPV） and anterior cerebral artery （ACA） blood flow parameters in IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Methods Preterm infants with gestational age ≤32 weeks and birth weight ≤ 1500 g admitted to the neonatal intensive care unit （NICU） were selected as the research subjects. All preterm infants were admitted within 1 hour after birth， and systolic blood pressure （SBP）， diastolic blood pressure （DBP）， and mean arterial blood pressure （MABP） were monitored every 1 hour interval. The difference between maximum and minimum values （max?min）， standard deviation （SD）， coefficient of variation （CV）， and successive variation （SV） were used as BPV indicators. On the 1st， 3rd， and 7th day of admission， transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 1st day， systolic velocity （Vs）， diastolic velocity （Vd）， and resistance index （RI） of ACA were measured simultaneously. Preterm infants were divided into IVH group and non IVH group based on the results of transcranial ultrasound examination， and the correlation between BPV indicators， ACA blood flow parameters， and the development of IVH was analyzed. Results A total of 92 preterm infants met the inclusion criteria， including 49 in the IVH group and 43 in the non IVH group. There was no statistically significant difference in baseline characteristics such as gestational age， birth weight， gender， and perinatal medical history between the two groups of preterm infants （P > 0.05）. SBP SD （OR = 1.480 95% CI：1.020 ~ 2.147）， and ACA?RI （OR = 3.027 95% CI： 2.769 ~ 3.591） are independent risk factors for IVH in preterm infants. The sensitivity and specificity of combined detection of SBP SD， and ACA?RI in predicting IVH were 61.2% and 79.1%， respectively. Conclusion High BPV and ACA?RI are related to IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Combined detection of SBP SD， and ACA?RI has a certain predictive effect on early identification of IVH.
| 1 | 江苏省新生儿脑损伤规范化诊疗研究协作组.江苏省早产儿脑损伤多中心临床流行病学调查［J］. 临床儿科杂志，2019，37（1）： 6-10. |
| 2 | PERLMAN J M. Periventricular-intraventricular?hemorrhage?in?the?premature?infant- A historical perspective［J］. Semin Perinatol， 2022， 46 （5）： 1-8. |
| 3 | CIZMECI M N， DE VRIES L S， LY L G， et al. Periventricular Hemorrhagic Infarction in Very Preterm Infants： Characteristic Sonographic Findings and Association with Neurodevelopmental Outcome at Age 2 Years［J］. J Pediatr， 2020，217（2）：79-85.e1. |
| 4 | HWANG-BO S， SEO Y M， OH M Y， et al. The prognosis of refractory hypotension and severe intraventricular?hemorrhage?in very low birth weight infants［J］. Medicine （Baltimore）， 2022， 101（30）： e29598. |
| 5 | LUO J， LUO Y， ZENG H， et al. Research Advances of Germinal Matrix Hemorrhage： An Update Review［J］. Cell Mol Neurobiol， 2019， 39 （1）： 1-10. |
| 6 | CHENG B， BALLABH P. Recovery of the brain after intraventricular hemorrhage［J］. Semin Fetal Neonatal Med， 2022， 27 （1）：1-8. |
| 7 | VESOULIS Z A， FLOWER A A， ZANELLI S， et al. Blood pressure extremes and severe IVH in preterm Infants［J］. Pediatr Res， 2020， 87（1）： 69-73. |
| 8 | LIGHTBURN M H， GAUSS C H， WILLIAMS D K， et al. Observational study of cerebral hemodynamics during dopamine treatment in hypotensive ELBW infants on the first day of life［J］. J Perinatol， 2013， 33（9）： 698-702. |
| 9 | PETER D S， GANDY C， HOFFMAN S B. Hypotension and adverseoutcomes in prematurity： comparing definitions［J］. Neonatology， 2017， 111（3）：228-233. |
| 10 | DACOSTA C S， CZOSNYKA M， SMIELEWSKI P， et al. Optimalmean arterial blood pressure in extremely preterm infants within thefirst 24 hours of life［J］. J Pediatr，2018， 203（12）：242-248. |
| 11 | MIALL-ALLEN V M， DE VRIES L S， WHITELAW A G. Mean arterial blood pressure and neonatal cerebral lesions［J］. Arch Dis Child， 1987， 62（10）：1068-1069. |
| 12 | VESOULIS Z A， TERS N M EL， WALLENDORF M， et al. Empirical estimation of the normative blood pressure in infants <28 weeks gestation using a massive data approach［J］. J Perinatol， 2016， 369（4）：291-295. |
| 13 | ESCOURROU G， RENESME L， ZANA E， et al. How to assess hemodynamic status?in?very preterm newborns?in?the first week of life？［J］. J Perinatol， 2017， 37（9）： 987-993. |
| 14 | ZUBROW A B， HULMAN S， KUSHNER H，et al. Determinants of blood pressure in infants admitted to neonatal intensive care units： a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group［J］. J Perinatol， 1995， 15（6）：470-479. |
| 15 | PARATI G， STERGIOU G S， DOLAN E， et al. Blood pressure variability： clinical relevance and application［J］. J Clin Hypertens （Greenwich）， 2018， 20（7）：1133-1137. |
| 16 | PARATI G， OCHOA J E， LOMBARDI C， et al. Blood pressure variability： assessment， predictive value， and potential as a therapeutic target［J］. Curr Hypertens Rep， 2015， 17（4）：537-555. |
| 17 | PAPILE L A， BURSTEIN J， BURSTEIN R， et al. Incidence and evolution of subependymal and intraventricular hemorrhage： a study of infants with birth weights less than 1，500 gm［J］. J Pediatr， 1978， 92（4）：529-534. |
| 18 | 王彤，柯淑兰，吴轶，等. H型高血压患者血压变异性与同型半胱氨酸及脂联素的相关性［J］. 实用医学杂志，2018，34（19）：3211-3214. |
| 19 | DA J， ZHANG Z， SHEN Y， et al. Blood pressure variability is independent of systolic pressure in adolescent and young adult patients undergoing hemodialysis［J］. Pediatr Res， 2018， 83（3）：615-621. |
| 20 | GARVEY A A， WALSH B H， INDER T E. Pathogenesis and prevention of intraventricular hemorrhage［J］.Semin Perinatol， 2022， 46（5）： 151592. |
| 21 | SOUL J S， HAMMER P E， TSUJI M， et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants［J］. Pediatric research， 2007， 61 （4）： 467-473. |
| 22 | RHEE C J， FRASER C D， KIBLER K， et al. The ontogeny of cerebrovascular pressure autoregulation in premature infants［J］. Acta Neurochir Suppl， 2014， 34（12）： 926-931. |
| 23 | AL-AWEEL I， PURSLEY D M， RUBIN L P， et al. Variations in prevalence of hypotension， hypertension， and vasopressor use in NICUs［J］. J Perinatol， 2010， 21（5）： 272-278. |
| 24 | BADA H S， KORONES S B， PERRY E H， et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage［J］. J Pediatr， 1990， 117（4）： 607-614. |
| 25 | BEL F V， BOR M V D， STIJNEN T， et al. Aetiological r?le of cerebral blood-flow alterations in development and extension of peri-intraventricular haemorrhage［J］. Dev Med Child Neurol， 1987， 29（5）： 601-614. |
| 26 | HUANG X， GUO H， YUAN L， et al. Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status［J］. Ther Adv Neurol Disord， 2021， 14（5）： 1-13. |
| 27 | ALTIT G， BHOMBAL S， CHOCK V Y. Cerebral saturation reflects anterior cerebral artery flowparameters by Doppler ultrasound in the extremelypremature newborn［J］. J Perinatol， 2022， 42（2）：1-6. |
| 28 | FARAG M M， GOUDA M H， ALMOHSEN A M A， et al. Intraventricular hemorrhage prediction in premature neonates in the era of hemodynamics monitoring： a prospective cohort study［J］. Eur J Pediatr， 2022， 181（12）： 4067-4077. |
| 29 | BAIK-SCHNEDITZ N， HOLLER N， URLESBERGER B， et al. Cerebral Doppler Resistance Index （RI） is associated with regional cerebral oxygenation［J］. Acta Paediatr， 2020， 109（11）：2299-2301. |
| 30 | ARGOLLO N， LESSA I， RIBEIRO S. Cranial Doppler resistance index measurement in preterm newborns withcerebral white matter lesion［J］. J Pediatr， 2006， 82（3）：221-226. |
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