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目的运用超声应变率显像(SRI)技术测定缺氧缺血性脑病(HIE)患儿左心室侧壁的位移,以此评价患儿心功能受损情况,及早为临床提供治疗信息。方法选取2009年1月至2011年5月40例HIE新生患儿,按临床轻、中度分级各20例,胎龄37.8～40.9周,平均胎龄39.5周;体质量2.83～3.89kg,平均体质量3.34kg。并选取20例正常出生足月儿做对照组,胎龄38.2～41.1周,平均胎龄40.1周;体质量2.92～3.68kg,平均体质量3.26 kg。分别采集大脑中动脉(MCA)的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI);标准四腔心切面,应用应变率技术测量左心室侧壁基底段及中间段的收缩期应变率(SSR)、舒张早期应变率(ESR)、舒张晚期应变率(ASR);二、三尖瓣口血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及左心室射血分数(LVEF),对所获指标进行定量分析。结果轻度和中度HIE组与正常对照组比较,其MCA血流的Vs和Vd均减低(P<0.01),RI均增加(P<0.05);中度HIE组LVEF较正常新生儿LVEF低,轻度者无明显变化,但两组患儿的左心室壁基底段、中间段位点的收缩期位移低于对照组(P<0.05),差异具有统计学意义。结论超声应变率技术可无创、敏感、准确地评价HIE患儿的心功能变化,为临床提供治疗信息。
Objective To evaluate the impaired cardiac function in children with hypoxic-ischemic encephalopathy (HIE) using ultrasound strain rate imaging (SRI) to assess the cardiac function in children with hypoxic-ischemic encephalopathy (HIE) and to provide early clinical information. Methods Forty neonates with HIE from January 2009 to May 2011 were selected. According to the clinical grades of mild and moderate grade, there were 20 cases with gestational age ranging from 37.8 to 40.9 weeks with an average gestational age of 39.5 weeks and body weight ranging from 2.83 to 3.89 kg Body mass 3.34kg. Twenty healthy infants were selected as the control group. The gestational age ranged from 38.2 to 41.1 weeks with an average gestational age of 40.1 weeks. The body weight ranged from 2.92 to 3.68 kg with an average body weight of 3.26 kg. The peak systolic velocity (Vs), end diastolic velocity (Vd) and resistance index (RI) of the middle cerebral artery (MCA) were collected respectively. The standard four-chamber coronal section was measured by strain rate technique Systolic strain rate (SSR), early diastolic strain rate (ESR) and late diastolic strain rate (ASR) in the middle and middle segments of the tricuspid valve; second, tricuspid valve blood flow early diastolic peak velocity (E), late diastolic peak velocity A) and left ventricular ejection fraction (LVEF), quantitative analysis of the indicators obtained. Results Compared with the normal control group, the mild and moderate HIE groups showed lower Vs and Vd and lower RI (all P <0.05) in MCA blood flow, while LVEF in moderate HIE group was lower than that in normal neonates (P <0.05), but there was no significant change in the mild group. However, the systolic displacement of the basal segment and middle segment of the left ventricular wall in both groups was lower than that of the control group (P <0.05), and the difference was statistically significant. Conclusion The ultrasonic strain rate technique can evaluate the changes of cardiac function in children with HIE without any invasiveness and sensitivity, and provide the information of clinical treatment.