CAJ | 학술논문

目的应用组织多普勒显像(DTI)评价窒息后新生儿心功能.方法足月窒息新生儿62例,根据Apgar评分分为重度窒息组(Apgar评分≤3分)31例,轻度窒息组(Apgar评分>3分且≤7分)31例.在出生后24、48、72 h应用DTI测定各组的二尖瓣前叶收缩期运动速度(OTIs),舒张早期峰值运动速度(DTIe),舒张晚期峰值运动速度(OTIa),(DTIe/a)比值,对比M型超卢的左心室射血分数(LVEF)及脉冲多普勒超声心动图的二尖瓣E峰、A峰值及比值(E/A),并与正常新生儿(对照组)30例对照.结果 LVEF仅在重度窒息组24 h内[(62±4)cm/s]明显低于对照组(P<0.05),而DTIs在3个时段均明显低于对照组,重度窒息组内24 h明显低于48 h[(3.9±0.4)cm/s比(5.3±0.8)cm/s]、72 h[(5.0±0.9)cm/s](均P<0.01).E、E/A在72 h时重度窒息组(55±12,0.94±0.25)与轻度窒息组(51±10,0.89±0.20)均明显低于对照组(均P<0.01),A峰值(60±7)明显高于对照组(P<0.01),而DTIe(5.6±1.2、5.7±0.9、5.6 ±0.9)、e/a(0.64±0.14、0.69±0.11、0.61±0.12)在3个时段均明显低于对照组,DTIa3个时段(8.5±0.7、8.9±1.5、8.9±1.4)均明显高于对照组(均P<0.01).结论新生儿窒息后左心收缩功能、舒张功能均降低,DTI指标较M型超声与脉冲多普勒超声心动图指标更能灵敏的反映心功能的改变.
목적 응용조직다보륵현상(DTI)평개질식후신생인심공능.방법 족월질식신생인62례,근거Apgar평분분위중도질식조(Apgar평분≤3분)31례,경도질식조(Apgar평분>3분차≤7분)31례.재출생후24、48、72 h응용DTI측정각조적이첨판전협수축기운동속도(OTIs),서장조기봉치운동속도(DTIe),서장만기봉치운동속도(OTIa),(DTIe/a)비치,대비M형초로적좌심실사혈분수(LVEF)급맥충다보륵초성심동도적이첨판E봉、A봉치급비치(E/A),병여정상신생인(대조조)30례대조.결과 LVEF부재중도질식조24 h내[(62±4)cm/s]명현저우대조조(P<0.05),이DTIs재3개시단균명현저우대조조,중도질식조내24 h명현저우48 h[(3.9±0.4)cm/s비(5.3±0.8)cm/s]、72 h[(5.0±0.9)cm/s](균P<0.01).E、E/A재72 h시중도질식조(55±12,0.94±0.25)여경도질식조(51±10,0.89±0.20)균명현저우대조조(균P<0.01),A봉치(60±7)명현고우대조조(P<0.01),이DTIe(5.6±1.2、5.7±0.9、5.6 ±0.9)、e/a(0.64±0.14、0.69±0.11、0.61±0.12)재3개시단균명현저우대조조,DTIa3개시단(8.5±0.7、8.9±1.5、8.9±1.4)균명현고우대조조(균P<0.01).결론 신생인질식후좌심수축공능、서장공능균강저,DTI지표교M형초성여맥충다보륵초성심동도지표경능령민적반영심공능적개변.
Objective To investigate the value of Doppler tissue imaging (DTI) in evaluation the changes of cardiac function after neonatal asphyxia. Methods Sixty-two full-term neonates suffering from asphyxia at birth were divided into 2 groups according to Apgar scores : severe asphyxia group with the Apgarscores ≤3 (n = 31 ) and mild asphyxia group with the Apgar scores > 3 and ≤ 7 ( n = 31 ). Thirty normal neonates were used as control group. DTI was conducted 24, 48, and 72 hours after birth to measure the values of systolic peak myocardial motion velocity ( DTIs), early diastolic peak myocardial motion velocity (TDIe), late diastolic peak myocardial motion velocity (DTIa) and DTI e/a of anterior leaflet of mitral valve, and the values were compared with the left ventricular ejection fraction (LVEF) measured by M-mode ultrasound and the values of E, A, and E/A of mitral valve shown in pulsed Doppler echocardiogTaphy. Results The LVEF of the severe asphyxia group measured 24 h after birth was (62 ±4)cm/s, significantly lower than that of the control group (P < 0.05), while the values of DTIs 24, 48, and 72 hours of the severe asphyxia group were all significantly lower than those of the control group ( all P < 0. 05 ). In the severe asphyxia group the DTIs value 24 hours [ (3.9 ± 0.4) cm/s ] after the birth was significantly lower than those 48 and 72 hours after birth [ (5.3 ± 0.8 )cm/s, (5.0 ± 0.9 )cm/s, both P < 0.01 ]. The values of E and E/A of the severe asphyxia group(55 ± 12,0.94 ± 0.25 )72 h after birth of the mild asphyxia group (51 ± 10,0.89 ± 0.20) were both significantly lower than those of the control group ( both P < 0.01 ), the value of A 72 h after birth of the mild asphyxia group ( 60 ± 7 ) was significantly higher than that of the control group (P < 0.01 ). The values of DTIe and DTIe/a 24, 48, and 72 h after birth of the mild asphyxia group were all significantly lower than those of the control group, and the values of DTIa 24, 48, and 72 h after birth of the mild asphyxia group were all significantly higher than those of the control group ( all P <0.01 ). Conclusion After neonatal asphyxia, both the systolic function and the diastolic function of the left ventricle decrease; and the DTI indexes can reflect the cardiac function changes more sensitively than M-mode ultrasound indexes.