CAJ | 학술논문

目的：探讨彩色多普勒超声动态监测窒息新生儿肾动脉主干血流动力学改变的临床意义。资料与方法60例窒息新生儿根据出生后1 min Apgar评分分为轻度窒息组（38例）和重度窒息组（22例），采用彩色多普勒超声监测窒息新生儿出生后第1天及第3天肾动脉主干收缩期峰值流速（Vs）、舒张末期流速（Vd）、阻力指数（RI）及尿内皮素-1（ET-1）水平。以同期20例健康足月新生儿作为对照。结果出生后第1天，轻度窒息组及重度窒息组患儿肾动脉主干血流Vs、Vd均较对照组降低、RI增大（P<0.05），重度窒息组变化更显著（P<0.05）；出生后第3天，轻度窒息组及重度窒息组患儿肾动脉主干血流Vs、Vd较第1天下降，RI较第1天增大，且重度窒息组Vd及RI变化更显著（P<0.01）。轻度窒息组及重度窒息组患儿出生后第1天、第3天尿ET-1水平均较对照组增高（P<0.01），且重度窒息组升高更显著（P<0.05）。轻度窒息组及重度窒息组患儿第1天、第3天肾动脉主干血流Vs、Vd与尿ET-1水平均呈显著负相关（r=-0.823、-0.845, P<0.01），RI与尿ET-1水平呈显著正相关（r=0.785, P<0.01）。结论彩色多普勒超声监测新生儿肾动脉主干血流动力学改变与尿ET-1检测均可以动态、无创地反映窒息新生儿肾损伤的程度。
목적：탐토채색다보륵초성동태감측질식신생인신동맥주간혈류동역학개변적림상의의。자료여방법60례질식신생인근거출생후1 min Apgar평분분위경도질식조（38례）화중도질식조（22례），채용채색다보륵초성감측질식신생인출생후제1천급제3천신동맥주간수축기봉치류속（Vs）、서장말기류속（Vd）、조력지수（RI）급뇨내피소-1（ET-1）수평。이동기20례건강족월신생인작위대조。결과출생후제1천，경도질식조급중도질식조환인신동맥주간혈류Vs、Vd균교대조조강저、RI증대（P<0.05），중도질식조변화경현저（P<0.05）；출생후제3천，경도질식조급중도질식조환인신동맥주간혈류Vs、Vd교제1천하강，RI교제1천증대，차중도질식조Vd급RI변화경현저（P<0.01）。경도질식조급중도질식조환인출생후제1천、제3천뇨ET-1수평균교대조조증고（P<0.01），차중도질식조승고경현저（P<0.05）。경도질식조급중도질식조환인제1천、제3천신동맥주간혈류Vs、Vd여뇨ET-1수평균정현저부상관（r=-0.823、-0.845, P<0.01），RI여뇨ET-1수평정현저정상관（r=0.785, P<0.01）。결론채색다보륵초성감측신생인신동맥주간혈류동역학개변여뇨ET-1검측균가이동태、무창지반영질식신생인신손상적정도。
Purpose To explore the clinical value of color Doppler ultrasound in monitoring hemodynamic changes in main renal artery of neonatal asphyxia. Materials and Methods A total of 60 cases of neonatal asphyxia were divided into mild asphyxia (38 cases) and severe asphyxia (22 cases) according to Apgar score 1 min after born. Then the peak systolic velocity (Vs), the end diastolic velocity (Vd) and the resistance index (RI) of the main renal artery were obtained by color Doppler ultrasound on day 1 and day 3;the level of endothelin-1 (ET-1) was also recorded accordingly. The above results were compared with those of 20 cases of healthy full-term new born infants. Results On day 1, Vs and Vd of the main renal artery in the groups with mild asphyxia and severe asphyxia were both lower than those in healthy group (P<0.05), but RI was higher (P<0.05), with more dramatic changes in the group with severe asphyxia (P<0.05). On day 3, Vs and Vd in the groups with mild asphyxia and severe asphyxia reduced compared with those on day 1, whilst RI was higher than that on day 1. Vd and RI in the group with severe asphyxia changed more significantly (P<0.01). As to the value of ET-1, both groups with mild asphyxia and severe asphyxia showed higher level than healthy group (P<0.01). More dramatic increase appeared in the group with severe asphyxia (P<0.05). In the groups with mild asphyxia and severe asphyxia, the Vs and Vd of the main renal artery were negatively correlated with ET-1 on day 1 and day 3 (r=-0.823,-0.845;P<0.01), while the RI was positively correlated with ET-1 (r=0.785, P<0.01). Conclusion Both color Doppler ultrasound imaging and neonatal urine ET-1 test can reflect degree of renal injury after neonatal asphyxia dynamically and noninvasively, which can be used to evaluate the injury severity.