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目的观察新生儿窒息后肺动脉高压的发生对其心功能的影响。方法将2006年1～7月上海复旦大学附属儿科医院收治的42例新生儿窒息患者分为合并肺动脉高压组(21例)和无肺动脉高压组(21例),测定其心率、体循环收缩压,复苏后6～12h测定血清中肌酸激酶心肌同工酶(CK-MB)和心肌钙蛋白I(cTnI)含量;运用超声心动图检测各项心功能指标,包括左室射血分数(LVEF)、右室射血分数(RVEF)、二尖瓣口舒张期血流E/A比值(ME/A)、三尖瓣口舒张期血流E/A比值(TE/A)、左室等容舒张时间LVIRT,肺动脉血流加速时间/射血时间比值(RVACT/ET)。结果肺动脉高压组LVEF、RVEF、ME/A、TE/A分别为(58.47±7.85)%,(52.85±8.34)%,0.93±0.20,0.77±0.18均明显低于对照组[(63.46±6.80)%,(62.92±6.70)%,1.09±0.23,0.34±0.18,均P<0.05],以RVEF、TE/A降低更为显著。肺动脉高压组IVRT明显延长,RVACT/ET缩短。两组血清CK-MB水平均高于正常,但两组间无统计学差异;两组间在临床表现、心率、体循环收缩压也无明显差别。结论新生儿窒息后若合并肺动脉高压,可进一步加重心肌损害以及心功能特别是右心收缩、舒张功能的损害。早期干预可改善患儿的预后。
Objective To observe the impact of pulmonary hypertension after neonatal asphyxia on its cardiac function. Methods 42 cases of neonatal asphyxia admitted to Shanghai Children’s Hospital of Fudan University from January to July 2006 were divided into two groups: 21 patients with pulmonary hypertension and 21 patients without pulmonary hypertension, and their heart rate, systolic blood pressure, Serum CK-MB and cTnI levels were measured 6 ~ 12 h after resuscitation. The cardiac function indexes including left ventricular ejection fraction (LVEF) , Right ventricular ejection fraction (RVEF), mitral valve diastolic blood flow E / A ratio (ME / A), tricuspid valve diastolic blood flow E / A ratio LVIRT, pulmonary artery flow acceleration time / ejection ratio (RVACT / ET). Results The levels of LVEF, RVEF, ME / A and TE / A in pulmonary hypertension group were (58.47 ± 7.85)%, (52.85 ± 8.34)%, 0.93 ± 0.20 and 0.77 ± 0.18 respectively, which were significantly lower than those in control group [(63.46 ± 6.80) %, (62.92 ± 6.70)%, 1.09 ± 0.23,0.34 ± 0.18, all P <0.05]. The decrease of RVEF and TE / A was more significant. IVRT was significantly prolonged in pulmonary hypertension group and RVACT / ET was shortened. Serum CK-MB levels in both groups were higher than normal, but there was no significant difference between the two groups; there was no significant difference in clinical manifestations, heart rate and systemic systolic blood pressure between the two groups. Conclusions If neonatal asphyxia with pulmonary hypertension, can further aggravate myocardial damage and cardiac function, especially right ventricular systolic and diastolic dysfunction. Early intervention can improve the prognosis of children.