摘要
目的观察新生儿窒息后肺动脉高压的发生对其心功能的影响。方法将2006年1～7月上海复旦大学附属儿科医院收治的42例新生儿窒息患者分为合并肺动脉高压组(21例)和无肺动脉高压组(21例),测定其心率、体循环收缩压,复苏后6～12h测定血清中肌酸激酶心肌同工酶(CK-MB)和心肌钙蛋白I(cTnI)含量;运用超声心动图检测各项心功能指标,包括左室射血分数(LVEF)、右室射血分数(RVEF)、二尖瓣口舒张期血流E/A比值(ME/A)、三尖瓣口舒张期血流E/A比值(TE/A)、左室等容舒张时间LVIRT,肺动脉血流加速时间/射血时间比值(RVACT/ET)。结果肺动脉高压组LVEF、RVEF、ME/A、TE/A分别为(58.47±7.85)%,(52.85±8.34)%,0.93±0.20,0.77±0.18均明显低于对照组[(63.46±6.80)%,(62.92±6.70)%,1.09±0.23,0.34±0.18,均P<0.05],以RVEF、TE/A降低更为显著。肺动脉高压组IVRT明显延长,RVACT/ET缩短。两组血清CK-MB水平均高于正常,但两组间无统计学差异;两组间在临床表现、心率、体循环收缩压也无明显差别。结论新生儿窒息后若合并肺动脉高压,可进一步加重心肌损害以及心功能特别是右心收缩、舒张功能的损害。早期干预可改善患儿的预后。
Objective To investigate the changes of heart function in the newborns with pulmonary hypertention induced by asphyxia. Methods Forty-one neonatal patients with asphyxia admitted to NICU were divided into two groups, pulmonary hypertension（PH） group（ n =21） and control（ C） group（ n =21） ;heart rate（ HR） and blood systolic pressure （ BSP） were measured and the level of serum creatine kinase MB（ CK-MB） were detected in 6 - 12 hours after resuscitation. Cardiac functions were evaluated by echocardiography. Parameters included left ventricular ejection fraction （LVEF） ,right ventricular ejection fraction（RVEF） ,ratio of peak E velocity and peak A velocity of mitral flow and tricuspid flow （ MVE/A and TVE/A） ,isovalumic relaxation time of left ventricle （LVIRT） , ratio of accelerative time and ejecrive time of pulmonary arterial flow（ RVACT/ET）. Results The LVEF, RVEF, ME/A, and TE/A in PH group[ （58.47 ± 7.85 ） %, （ 52. 85 ± 8.34 ） % ,0. 93 ± 0. 20,0. 77 ±0. 18, respectively ] were all lower than those in C group [ （ 63.46 ± 6. 80 ） %, （62. 92 ± 6. 70 ） %, 1. 09 ± 0. 23,0. 34 ± 0. 18, respectively, P 〈 0. 05 ] ; Contrast to C group, LVIRTc was longer and RVACT/ET was shorter in PH group. There were no significant differences in HR, BSP, and CK-MB between PH group and C group. Conclusion Pulmonary hypertension of newborn induced by asphyxia can worsen myocardial impairment and cardiac function, especially the fight ventricular function. Early management can improve the prognosis of the patients.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第9期667-669,共3页
Chinese Journal of Practical Pediatrics
关键词
新生儿
窒息
肺动脉高压
心功能
Newborn
Asphyxia
Pulmonary hypertension
Cardiac function
