CAJ | 학술논문

目的探讨早产儿胎儿肺成熟度和心力储备(CCR)间的相关性。方法选择2008年7月至2009年8月于四川大学华西第二医院产科住院分娩的36例出生后2 h以内早产儿为研究对象,采用羊水泡沫试验及羊水板层小体计数(LBC)检测本组早产儿的胎儿肺成熟度；根据胎儿肺成熟度,将其分为胎儿肺不成熟组(n=17),胎儿肺可疑成熟组(n=3)和胎儿肺成熟组(n=16)。采用心音图实验(PCGT)检测CCR指标,包括第一心音幅值(S1)与第二心音幅值(S2)的比值(S1/S2)、心脏舒张期时限(D)与收缩期时限(S)的比值(D/S)和应激后心力变化趋势(CCCTS)；采用线性回归分析各指标与早产儿胎儿肺成熟度之间的相关性(本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书)。各组早产儿出生体质量、身长等一般情况比较,差异无统计学意义(P>0.05)。结果早产儿胎儿肺成熟度与孕龄成正相关(r=0.536,P=0.001)；3组间 S1/S2和 CCCTS 比较,其差异无统计学意义(H=0.013,1.651,均 P>0.05)；3组间D/S比较,仅胎儿肺成熟早产儿组较胎儿肺不成熟早产儿组高,其差异有统计学意义(q=0.088,P=0.023)。CRR指标与胎儿肺成熟度的偏相关分析结果显示,早产儿胎儿肺成熟度与 S1/S2、CCCTS 不相关(r=0.1892,0.2890,均P>0.05)；与D/S成正相关(r=0.4014,P=0.017)。结论成熟的胎儿肺发育可使早产儿心肌灌注时间延长,心肌获得较多氧气和营养,使其 CCR较高；胎儿肺不成熟早产儿CCR低,出生后应加强对心脏功能的保护。通过对 D/S 和胎儿肺成熟度相关关系的深入研究,有可能找到判断胎儿肺成熟度的新方法。
목적탐토조산인태인폐성숙도화심력저비(CCR)간적상관성。방법선택2008년7월지2009년8월우사천대학화서제이의원산과주원분면적36례출생후2 h이내조산인위연구대상,채용양수포말시험급양수판층소체계수(LBC)검측본조조산인적태인폐성숙도；근거태인폐성숙도,장기분위태인폐불성숙조(n=17),태인폐가의성숙조(n=3)화태인폐성숙조(n=16)。채용심음도실험(PCGT)검측CCR지표,포괄제일심음폭치(S1)여제이심음폭치(S2)적비치(S1/S2)、심장서장기시한(D)여수축기시한(S)적비치(D/S)화응격후심력변화추세(CCCTS)；채용선성회귀분석각지표여조산인태인폐성숙도지간적상관성(본연구준순적정서부합사천대학화서제이의원인체시험위원회제정적윤리학표준,득도해위원회비준,분조정득수시대상감호인지정동의,병여감호인첨서림상연구지정동의서)。각조조산인출생체질량、신장등일반정황비교,차이무통계학의의(P>0.05)。결과조산인태인폐성숙도여잉령성정상관(r=0.536,P=0.001)；3조간 S1/S2화 CCCTS 비교,기차이무통계학의의(H=0.013,1.651,균 P>0.05)；3조간D/S비교,부태인폐성숙조산인조교태인폐불성숙조산인조고,기차이유통계학의의(q=0.088,P=0.023)。CRR지표여태인폐성숙도적편상관분석결과현시,조산인태인폐성숙도여 S1/S2、CCCTS 불상관(r=0.1892,0.2890,균P>0.05)；여D/S성정상관(r=0.4014,P=0.017)。결론성숙적태인폐발육가사조산인심기관주시간연장,심기획득교다양기화영양,사기 CCR교고；태인폐불성숙조산인CCR저,출생후응가강대심장공능적보호。통과대 D/S 화태인폐성숙도상관관계적심입연구,유가능조도판단태인폐성숙도적신방법。
Objective To study the correlation between fetal lung maturity and cardiac contractility reserve(CCR)of premature infants.Methods A total of 3 6 cases of premature infants within 2 h after birth who were hospitalized delivery in West China Second University Hospital,Sichuan University from July 2008 to August 2009 were investigated in this study.Use foam test of amniotic fluid and amniotic fluid lamellar body count(LBC)to detect fetal lung maturity.According to the fetal lung maturity,they were divided into fetal lung immature group(n=17),fetal lung questionable mature group(n=3)and fetal lung mature group (n=16 ).Use phonocardiogram test to measure CCR which included:first heart sound amplitude/second heart sound amplitude (S1/S2 ),diastolic phase/systolic phase (D/S ) and cardiac contractility change trend after stimulation(CCCTS).The linear regression analysis was used to analyze the correlation between the fetal lung maturity and CCR of the premature infants.The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital,Sichuan University .Informed consent was obtained from the parents of each participating patient. The general statistics such as birth weight and length in each group had no significant difference(P>0.05). Results The fetal lung maturity has positive correlation with the gestational age(r=0.536,P=0.001). Compare S1/S2 and CCCTS of three groups ,had no significant difference(H=0.013,1.651,P>0.05), while the D/S of premature infants had significant difference between fetal lung immature group and fetal lung mature group(q=0.088,P=0.023).The lung maturity had no correlation with the S1/S2 and CCCTS (r=0.189 2,0.289 0,P>0.05),and had positive correlation with the D/S(r=0.401 4,P=0.017). Conclusions The more mature the fetal lung is,the longer time for myocardial perfusion,and more oxygen or nutrition cardiac muscle get can make higher CCR of premature infants.It is necessary to strengthen the heart care for the premature infants,especially those with immature fetal lung.In addition,it showed through the father study about the correlation between D/S and fetal lung maturity,maybe we could find a new way to test the fetal lung maturity.