雾化吸入硝酸甘油对新生儿缺氧性心肌损害的保护作用  

The protective effect of inhalation of nebulized nitroglycerin in neonatal heart impairment induced by hypoxia

作　　者：徐孝华 黄国英[2] 

机构地区：[1]南通瑞慈儿童医院新生儿科,江苏省226010 [2]复旦大学附属儿科医院心血管中心

出　　处：《中华临床医师杂志（电子版）》2011年第16期4713-4717,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察雾化吸入硝酸甘油(NTG)对新生儿缺氧性心肌损害的保护作用。方法选择窒息新生儿65例,根据有无肺动脉高压分为实验组(NTG组)33例和对照组32例,复苏后NTG组给予雾化吸入NTG。治疗前后采用多普勒超声心动图监测各项心功能指标,以及检测血清中肌酸激酶心肌同工酶(CK-MB)和肌钙蛋白I(cTnI)的改变。结果 (1)NTG组NTG吸入后各项心功能指标显著上升。与吸入前比较,吸入后12～24h、48～72h,LVEF从(58.92±6.58)%升至(66.48±5.08)%、(70.22±4.96)%(P<0.01);FS从(29.09±4.37)%升至(34.30±3.79)%、(37.13±3.95)%(P<0.01);RVEF从(54.89±8.64)%升至(66.23±7.12)%、(68.72±5.98)%(P<0.01);二尖瓣E/A从0.93±0.18升至1.05±0.21、1.13±0.19(P<0.01);三尖瓣E/A从0.79±0.15升至1.06±0.27、1.07±0.21(P<0.01);对照组相同时点各项指标较基础状态均无改善,无统计学差异。(2)与对照组相比,NTG组基础状态下LVEF、FS、RVEF、二尖瓣E/A、三尖瓣E/A均明显低于对照组(P<0.01),12～24h后RVEF、三尖瓣E/A均高于对照组(P<0.05),LVEF、FS、二尖瓣E/A与对照组已无差异;48～72h后NTG组各项心功能指标均高于对照组(P<0.05)。(3)NTG组血清CK-MB在NTG吸入前为(94.25±26.11)IU/L,与对照组相仿,NTG吸入后CK-MB降为(34.88±8.56)IU/L,低于对照组;NTG组cTnI在NTG吸入前为(0.74±0.19)ng/ml,明显高于对照组,NTG吸入后cTnI降为(0.32±0.08)ng/ml,与对照组相仿。结论 NTG吸入能有效地减轻急性低氧性心肌损害,改善心功能。起效迅速,无明显毒副作用。Objective Perinatal exposure to hypoxia is considered to be a cause of hypoxie-ischemic myocardial impairment in newborn associated with increase of pulmonary artery pressure and pulmonary vascular resistance.Recent studies suggest that inhaled nitric oxide(NO)may play an important role in the pathophysiology of pulmonary hypertension,and exert novel cardioprotection.But it's difficult to apply in practice because the cost is expensive and the operation is complicated.Nitroglycerin(NTG),as one of NO donors,can release NO and thereby provide a means of delivering NO to its site of action which is a potent vascular smooth muscle relaxant.The aim of the present study was to observe and evaluate the efficacy and security of inhalation of nebulized nitroglycerin on neonatal heart impairment induced by hypoxia.Methods A total of 65 neonates with hypoxia were divided into two groups according to pulmonary arterial pressure.NTG group(33 cases)with pulmonary hypertension was treated with inhaled nebulized nitroglycerin.The control group(32 cases) had no pulmonary hypertension.All the neonates underwent serial echocardiography evaluation before and during therapy to estimate the heart function,parameters included left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF),ratio of peak E velocity and peak A velocity of mitral flow and tricuspid flow(MV E/A and TV E/A),isovalumic relaxation time of left ventricle(IVRT),ratio of accelerative time of pulmonary artery and ejective time of right ventricle(AT/RVET),and detect the level of CK-MB and cTnI in serum before and 4 days after therapy.Results(1)In the NTG group,both of the diastolic function and systolic function of RV and LV ameliorated obviously after inhalation of nebulized nitroglycerin,especially RV function.Contrast to baseline,LVEF increased from(58.92±6.58)% to(66.48±5.08)% and(70.22±4.96)%,and FS from(29.09±4.37)% to(34.30±3.79)% and(37.13±3.95)%,RVEF from(54.89±8.64)% to(66.23±7.12)% and(68.72±5.98)%,MV E/A from 0.93±0.18 to 1.

关 键 词：心肌损害 缺氧 硝酸甘油 婴儿 新生 雾化 

分 类 号：R722.1[医药卫生—儿科]