不同胎龄新生儿动脉导管自然闭合时间及心脏指数、外周血管阻力、血压的动态变化  

Time for spontaneous closure of ductus arteriosus and dynamic changes with cardiac index,peripheral vascular resistance,blood pressure of different gestational age neonates

作　　者：董慧茹[1] 何少茹[1] 郑曼利[1] 钟劲[1] 陈晓博[1] 刘玉梅[1] 粱穗新[1] 

机构地区：[1]广东省医学科学院、广东省人民医院新生儿科,广州510080

出　　处：《中华实用儿科临床杂志》2015年第14期1060-1063,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家“十二五”科技支撑计划项目（2011BAI11B22）

摘　　要：目的：探讨不同胎龄（GA）新生儿动脉导管自然闭合时间，并对比关闭前后心脏指数（CI）、外周血管阻力指数（SVRI）及血压的变化趋势。方法采用前瞻观察性研究，选取新生儿95例，其中足月儿20例，早产儿75例，根据 GA 分为4组：GA ﹤32周组（27例），32周≤GA ﹤34周组（25例），34周≤GA ﹤37周组（23例），GA≥37周组（20例）。所有研究对象于5个时间点（24 h、48 h、72 h、7 d 和14 d）分别使用超声心排出量监测仪（USCOM）测定 CI 及 SVRI，超声心动图（ECHO）监测动脉导管大小，并于每次测量时记录血压。结果34周≤GA ﹤37周、GA≥37周的新生儿出生24 h 动脉导管累积自然关闭率分别为61.0%和90.0%；32周≤GA ﹤34周早产儿出生24 h 动脉导管累积自然关闭率为44.0%；GA ﹤32周的早产儿出生72 h 动脉导管自然关闭率为59.1%，其中9例口服布洛芬治疗，1例行动脉导管结扎术；4个胎龄组于5个时间点动脉导管累积关闭率比较，差异均有统计学意义（χ2=6.756、4.735、18.890、11.366、28.159，P 均﹤0.05）。动脉导管关闭后 GA ﹤32周，32周≤GA ﹤34周，34周≤GA ﹤37周，GA≥37周4组的收缩压、舒张压及 SVRI 升高，与关闭前比较差异均有统计学意义（t =-32.561、-19.913、-31.791、4.760，P 均﹤0.0001；t =-25.091、-23.400、-21.147、2.240，P 均﹤0.05；t =-10.931、-9.975、-9.629、2.350，P 均﹤0.05）；GA ﹤32周组、32周≤GA ﹤34周组、34周≤GA ﹤37周组导管关闭后 CI 均较关闭前均下降，差异均有统计学意义（ t =9.244、6.515、5.996，P 均﹤0.001），GA≥37周组关闭前后 CI 无明显变化（t =0.940，P ﹥0.05）。结论胎龄越大，出生早期动脉导管自然关闭率越高，而胎龄﹤32周的早产儿仍有近1/3需要药物治疗或手术干预；动脉导管关闭后血流动力学波动较大，对于早产儿及时使用 USCOM 及 ECHO 可早期发现并治疗动脉�Objective To investigate the time for spontaneous closure of the ductus arteriosus and the trends of cardiac index（CI）,peripheral vascular resistance index（SVRI）and blood pressure of neonates with different gesta-tional ages（GA）. Methods A prospective observational study about 95 newborns,including 20 full - term and 75 pre-term infants were divided into 4 groups according to their GA as GA ﹤ 32 weeks（n = 27）,32 weeks≤GA ﹤ 34 weeks （n = 25）,34 weeks≤GA ﹤ 37 weeks（n = 23）,GA≥37 weeks（n = 20）. Patent ductus arteriosus was diagnosed by echocardiography（ECHO）at the time of 24 h,48 h,72 h,7 d and 14 d. CI,SVRI and blood pressure were measured with ultrasonic cardiac output monitor（USCOM）. Results The cumulative spontaneous closure rate of arterious ductus of 32 weeks≤GA ﹤34 weeks,34 weeks≤GA ﹤37 weeks group and GA≥37 weeks group at 24 h after birth was 44. 0% , 61. 0% and 90. 0% respectively. However the rate was only 59. 1% at 72 h with the GA less than 32 weeks,of which 9 cases needed ibuprofen and 1 patient was conducted ductus arteriosus ligation. The differences in cumulative closure rate among 4 groups based on GA at 5 time points were statistically significant（χ2 =6. 756,4. 735,18. 890,11. 366,28. 159,all P ﹤0. 05）. There was significant increase of systolic blood pressure,diastolic blood pressure and SVRI with ductus arte-riosus closure（t = -32. 561,-19. 913,-31. 791,4. 760,all P ﹤0. 000 1;t = - 25. 091,- 23. 400,- 21. 147,2. 240,all P ﹤0. 05;t = -10. 931,-9. 975,-9. 629,2. 350,all P ﹤ 0. 05）. Whereas CI significantly decreased in groups of GA ﹤32 weeks,32 weeks ≤GA ﹤34 weeks,34 weeks ≤GA ﹤37 weeks（t =9. 224,6. 515,5. 996,all P ﹤ 0. 001）and no sig-nificant changes in GA≥37 weeks（t =0. 940,P ﹥0. 05）. Conclusions With the increase of gestational age,the rate of naturally early arterial catheter closure is higher. Whereas there still are nearly one - third infants requiring medical or surgical intervention in the gr

关 键 词：动脉导管 婴儿 早产 心脏指数 外周血管阻力指数 血压 

分 类 号：R722.1[医药卫生—儿科]