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目的评估缺氧新生儿肺动脉高压(PAH)的发生及其对左室形态及功能的影响,探讨缺氧性PAH新生儿血浆脑利钠肽(BNP)水平与左室舒张功能的关系。方法选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室(NICU)收治的缺氧新生儿52例,根据彩色多普勒超声检查是否存在PAH分为PAH组(34例)与对照组(18例),比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果(1)与对照组相比,PAH组左室舒张末内径(LVDd)、右室内径(RV)、肺动脉内径(PA)明显增大(P<0.05);三尖瓣反流峰值(VTR)流速增快及肺动脉收缩压(PASP)升高(P<0.05),室间隔增厚不明显(P>0.05)。(2)PAH组二尖瓣口血流多普勒频谱A峰流速(AV)、舒张早期充盈时间速度积分(AVTI)及A峰流速与E峰流速比值(AV/EV)、左房充盈分数(AVTI/EVTI)均较对照组显著增加(P<0.01);PAH组的左室等容舒张时间(LIVRT)延长,但与对照组相比差异无统计学意义(P>0.05),EV、舒张末期充盈时间速度积分(EVTI)及E峰减速时间(DT)较对照组亦无明显改变(P>0.05)。(3)PAH组血浆BNP水平较对照组显著升高(P<0.05)。(4)相关分析表明,PASP与AV/EV比值呈正相关(r=0.4126,P<0.01);PAH组AV/EV比值与血浆BNP水平呈正相关(r=0.4326,P<0.01)。结论缺氧新生儿PAH已引起左室心肌重塑表现及左室舒张功能减低,监测血浆BNP水平对新生儿缺氧性PAH伴左心功能受损的早期诊断具有十分重要的临床意义。
Objective To evaluate the incidence of pulmonary hypertension (PAH) and its effect on left ventricular morphology and function in neonates with hypoxic conditions and to investigate the relationship between plasma brain natriuretic peptide (BNP) levels and left ventricular diastolic function in neonates with hypoxic PAH. Methods From November 2003 to November 2008, 52 cases of hypoxic neonates admitted to the Neonatal Intensive Care Unit (NICU) of People’s Liberation Army General Hospital and Children’s Hospital Affiliated to Beijing Military Region General Hospital were enrolled. According to the existence of color Doppler ultrasonography PAH was divided into PAH group (34 cases) and control group (18 cases). The relationship between color Doppler echocardiography and left ventricular diastolic function and plasma BNP level were compared between the two groups. Results Compared with the control group, left ventricular end diastolic diameter (LVDd), right ventricular diameter (RV) and pulmonary artery diameter (PA) in PAH group were significantly increased (P <0.05); peak tricuspid regurgitation ) Increased velocity and pulmonary artery systolic pressure (PASP) increased (P <0.05), ventricular septal thickening was not significant (P> 0.05). (2) A peak velocity (AV), early diastolic filling velocity time integral (AVTI), peak AV velocity (AV / EV), left atrial filling fraction (P <0.01). The left ventricular isovolumetric relaxation time (LIVRT) in PAH group was longer than that in control group (P> 0.05) The end-diastolic filling speed time integral (EVTI) and E peak decelerating time (DT) also had no significant change (P> 0.05) compared with the control group. Plasma BNP level in PAH group was significantly higher than that in control group (P <0.05). (4) Correlation analysis showed that there was a positive correlation between PASP and AV / EV (r = 0.4126, P <0.01). The AV / EV ratio in PAH group was positively correlated with plasma BNP level (r = 0.4326, P <0.01). Conclusion The hypoxic neonatal PAH has caused the left ventricular remodeling and left ventricular diastolic function decreased. It is of great clinical significance to monitor the plasma BNP level for the early diagnosis of neonatal hypoxic PAH with impaired left ventricular function.