无创心输出量参数对早产儿动脉导管未闭的诊断价值  

Diagnostic value of non-invasive cardiac output parameters in premature infants with patent ductus ;arteriosus

作　　者：李欢[1] 张应绩 杨传忠[1] 易琳 李辉桃 黄鹏[1] 林彦青 唐慧[1] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院新生儿科,518028

出　　处：《中华围产医学杂志》2016年第5期371-376,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的：探讨无创心输出量参数心脏指数（cardiac index，CI）和射血分钟距离（minute distance，MD）诊断早产儿动脉导管未闭（patent ductus arteriosus，PDA）的价值，并确定CI和MD的界值。方法收集本院2015年1月至6月收治的98例早产儿的临床资料。根据生后3 d内超声检查结果和是否需要使用药物关闭动脉导管，分为PDA处理组（30例）、PDA未处理组（28例）和正常早产儿组（40例）。生后3 d内，每天测量心输出量参数。采用t检验、方差分析和SNK-q检验进行统计学分析。采用受试者工作特性（receiver operating characteristic，ROC）曲线分析CI和MD对临床需处理PDA的诊断价值。结果通过ROC曲线初步分析发现，CI和MD对临床需处理PDA的诊断意义最具有代表性，故选择这2项参数进行研究。PDA处理组主动脉与肺动脉CI和MD明显高于PDA未处理组和正常早产儿组（P值均＜0.05）；PDA未处理组与正常早产儿组主动脉与肺动脉CI、MD差异无统计学意义（P值均＞0.05）。主动脉CI的最佳诊断界值为2.95 L/（min·m2），MD为21.50 m/min；肺动脉CI的最佳诊断界值为4.55 L/（min·m2），MD为26.50 m/min。主动脉CI和MD联合应用，对临床需处理PDA的预测敏感性为0.90，特异性为0.82；肺动脉CI和MD联合应用，其敏感性和特异性分别为0.87和0.82；主、肺动脉的CI和MD联合应用，预测临床需处理PDA的敏感性和特异性分别为0.80和0.88。结论无创心输出量参数主动脉及肺动脉CI、MD对临床需处理PDA有较好的诊断价值，联合应用能够提高特异性，对于早产儿动脉导管未闭早期治疗方案的制定具有一定的指导意义。当主动脉CI≥2.95 L/（min·m2）、MD≥21.50 m/min时，可初步判断早产儿存在临床需处理PDA；如同时肺动脉CI≥4.55 L/（min·m2）、MD≥26.50 m/min时，需及时采取关闭动脉导管治疗。Objective To investigate the diagnostic value of non-invasive cardiac output parameters：cardiac index （CI） and minute distance （MD）, in premature infants with patent ductus arteriosus （PDA） and determine the cut-off value. Methods Clinical data of 98 premature infants admitted to the neonatal intensive care unit from January 2015 to June 2015 were collected. These premature infants were divided into the treated PDA group （n=30）,the untreated PDA group （n=28） and the normal premature group （n=40） based on the results of echocardiogram in the first three days after birth and the use of drugs. Non-invasive cardiac output parameters were measured in the first three days after birth. The data were analyzed by t test, analysis of variance and SNK-q test. The diagnostic value of CI and MD for PDA was analyzed by the receiver operating characteristic curve. Results By preliminary analysis of the ROC curve,CI and MD were the most representative parameters for the diagnosis of PDA which need to be treated clinically, we thus chose CI and MD in this study. The aortic and pulmonary arterial CI and MD in the treated PDA group were significantly higher than in the untreated PDA group and the normal premature group （all P〈0.05）. There were no significant differences between the untreated PDA group and the normal premature group in the aortic and pulmonary arterial CI and MD （all P〉0.05）. The cut-off value of the aortic CI and MD was 2.95 L/（min·m2） and 21.50 m/min, respectively, while that of the pulmonary arterial CI and MD was 4.55 L/（min·m2） and 26.50 m/min, respectively. The sensitivity and specificity of the combined aortic CI and MD for the treated PDA group were 0.90 and 0.82, and those of combined pulmonary arterial CI and MD were 0.87 and 0.82;and those of combined aortic and pulmonary arterial CI and MD were 0.80 and 0.88, respectively. Conclusions The non-invasive cardiac output parameters CI and MD have good diagnostic value for the PDA needing clinical treatment, and

关 键 词：血流动力学 早产儿 动脉导管未闭 无创心输出量参数 

分 类 号：R722.6[医药卫生—儿科]