中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2014年
3期
18-21
,共4页
余瑕%林仙方%刘志聪%蔡洁
餘瑕%林仙方%劉誌聰%蔡潔
여하%림선방%류지총%채길
超声检查%婴儿,早产%动脉导管未闭%超声心动描记术
超聲檢查%嬰兒,早產%動脈導管未閉%超聲心動描記術
초성검사%영인,조산%동맥도관미폐%초성심동묘기술
Ultrasonography%Infant,premature%Ductus arteriosus,patent%Echocardiography
目的：探讨高频超声预测早产儿动脉导管早期自然关闭的价值。方法170名早产儿（孕周＜37周），均在出生后24 h内入院，高频及常规超声心动图连续观察动脉导管，首次超声心动图检查于出生后24 h内完成，以后每天随访观察至第7天，若此期间发现动脉导管已经闭合，则不再继续随访检查。其中16名早产儿动脉导管出生7 d内未自然关闭，为动脉导管早期未自然关闭（早期PDA）组，另从7 d内自然关闭组中随机选取32名早产儿作为对照组，分别采用高频探头及常规心脏探头测量动脉导管内径、左房前后径与主动脉根部内径比值（LA/AO）。结果早产儿动脉导管于24、48、72 h内自然关闭率分别约18.8%（32/170）、61.2%（104/170）、78.8%（134/170），7 d内达90.6%（154/170），即早产儿出生后早期动脉导管自然关闭率约90.6%（154/170）。高频超声对动脉导管二维及彩色血流长度完整显示率均高于常规超声[82%（39/48）vs 46%（22/48），P＜0.001，100%（48/48） vs 77.1%（37/48），P＜0.01]，差异有统计学意义。高频超声测得早期PDA组动脉导管的内径大于对照组[（2.08±0.4）mm vs（1.09±0.22）mm，P＜0.001]，以1.55 mm为临界值，预测早生儿出生后7 d内动脉导管自然关闭的敏感度、特异度分别为87.5%、90.6%，准确性为66.5%。结论高频超声能明确诊断早产儿PDA，在精确显示动脉导管结构上优于常规超声心动图；动脉导管内径越大，早期自然关闭可能性越小。
目的：探討高頻超聲預測早產兒動脈導管早期自然關閉的價值。方法170名早產兒（孕週＜37週），均在齣生後24 h內入院，高頻及常規超聲心動圖連續觀察動脈導管，首次超聲心動圖檢查于齣生後24 h內完成，以後每天隨訪觀察至第7天，若此期間髮現動脈導管已經閉閤，則不再繼續隨訪檢查。其中16名早產兒動脈導管齣生7 d內未自然關閉，為動脈導管早期未自然關閉（早期PDA）組，另從7 d內自然關閉組中隨機選取32名早產兒作為對照組，分彆採用高頻探頭及常規心髒探頭測量動脈導管內徑、左房前後徑與主動脈根部內徑比值（LA/AO）。結果早產兒動脈導管于24、48、72 h內自然關閉率分彆約18.8%（32/170）、61.2%（104/170）、78.8%（134/170），7 d內達90.6%（154/170），即早產兒齣生後早期動脈導管自然關閉率約90.6%（154/170）。高頻超聲對動脈導管二維及綵色血流長度完整顯示率均高于常規超聲[82%（39/48）vs 46%（22/48），P＜0.001，100%（48/48） vs 77.1%（37/48），P＜0.01]，差異有統計學意義。高頻超聲測得早期PDA組動脈導管的內徑大于對照組[（2.08±0.4）mm vs（1.09±0.22）mm，P＜0.001]，以1.55 mm為臨界值，預測早生兒齣生後7 d內動脈導管自然關閉的敏感度、特異度分彆為87.5%、90.6%，準確性為66.5%。結論高頻超聲能明確診斷早產兒PDA，在精確顯示動脈導管結構上優于常規超聲心動圖；動脈導管內徑越大，早期自然關閉可能性越小。
목적：탐토고빈초성예측조산인동맥도관조기자연관폐적개치。방법170명조산인（잉주＜37주），균재출생후24 h내입원，고빈급상규초성심동도련속관찰동맥도관，수차초성심동도검사우출생후24 h내완성，이후매천수방관찰지제7천，약차기간발현동맥도관이경폐합，칙불재계속수방검사。기중16명조산인동맥도관출생7 d내미자연관폐，위동맥도관조기미자연관폐（조기PDA）조，령종7 d내자연관폐조중수궤선취32명조산인작위대조조，분별채용고빈탐두급상규심장탐두측량동맥도관내경、좌방전후경여주동맥근부내경비치（LA/AO）。결과조산인동맥도관우24、48、72 h내자연관폐솔분별약18.8%（32/170）、61.2%（104/170）、78.8%（134/170），7 d내체90.6%（154/170），즉조산인출생후조기동맥도관자연관폐솔약90.6%（154/170）。고빈초성대동맥도관이유급채색혈류장도완정현시솔균고우상규초성[82%（39/48）vs 46%（22/48），P＜0.001，100%（48/48） vs 77.1%（37/48），P＜0.01]，차이유통계학의의。고빈초성측득조기PDA조동맥도관적내경대우대조조[（2.08±0.4）mm vs（1.09±0.22）mm，P＜0.001]，이1.55 mm위림계치，예측조생인출생후7 d내동맥도관자연관폐적민감도、특이도분별위87.5%、90.6%，준학성위66.5%。결론고빈초성능명학진단조산인PDA，재정학현시동맥도관결구상우우상규초성심동도；동맥도관내경월대，조기자연관폐가능성월소。
Objective To study the value of high frequency ultrasound in predicting spontaneous closure of patent duct arteriosus (PDA) in premature neonates. Methods One hundred and seventy premature neonates aged less than 37 weeks of gestation were enrolled. They were all admitted in the neonatal intensive care unit of Jinhua People′ s Hospital within 24 hours after birth. Echocardiographic examinations was conducted using GE′s Vivid I Portable color Doppler ultrasonography with routine cardiac probe (frequency 1.7-3.4 MHz) and high-frequency transducer (frequency 7.5 MHz). Up to the 7th day, the echocardiography was carried out every day after birth until the closure of PDA .They were divided to two groups according to whether spontaneous closure of PDA took place with in 7 days after birth (the control group) or not (the PDA group). There were 16 premature neonates in PDA group, including 6 male and 10 female. The mean gestational week at birth was (35.3±1.4) weeks. The mean birth weight was (2 330.9±325.5) g. Thirty-two premature neonates were included incontrol group, including 13 male and 19 female. The mean gestational week at birth was (35.0±1.3) weeks. The mean birth weight was (2 337.5±287.8) g. The clinical characteristics and echocardiographic parameters were compared between the two groups. Results The detection rates of high-frequency ultrasound and routine echocardiography were all 100%. The spontaneous closure rate of PDA in preterm infants at 24 hours, 48 hours, 72 hours were 18.8%(32/170), 61.2%(104/170), 78.8%(134/170) respectively. Within 7 days after birth, the closure rate was 90.6%(154/170), therefore the incidence of PDA in premature neonates was about 9.4%(16/170) in our study. The display rate of entire duct arteriosus using high frequency ultrasound was signiifcantly higher than that using routine ultrasound [82%(39/48) vs 46%(22/48), P<0.001, 100%(48/48) vs 77.1%(37/48), P<0.01]. The diameters of duct arteriosus in PDA group were signiifcantly larger than that in control group [(2.08±0.4) mm vs (1.09±0.22) mm, P<0.001]. However, the remaining echocardiographic parameters showed no signiifcant difference between the two groups (P>0.05). To predict the spontaneous closure of PDA in preterm neonates within 7 days after birth by high frequency ultrasound, the sensitivity, specificity and accuracy were 87.5%, 90.6% and 66.5% respectively using the cutoff point of 1.55 mm. While the sensitivity, speciifcity and accuracy were 75%, 93.7%, 44.15%by routine echocardiography with the cutoff point of 2.36 mm. Conclusions High-frequency ultrasound can conifrm the diagnosis of PDA in preterm infants and it is better than routine echocardiography in depicting the structure of arterial duct. The larger PDA diameter was suggestive of the lower possibility of spontaneous close.
