超声评估早产儿动脉导管未闭对体循环的影响  

Ultrasonic evaluation on the influence of patent ductus arteriosus on systemic circulation for preterm infants

作　　者：房亮[1] 邢飞 王雪燕[2] 秦诗阳[1] 周启立[3] 冯佩明[1] FANG Liang;XING Fei;WANG Xue - yan;QIN Shi - yang;ZHOU Qi - li;FENG Pei - ming(Department of Ultrasound ,Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei, China)

机构地区：[1]承德医学院附属医院超声科,河北承德067000 [2]承德医学院附属医院风湿免疫科,河北承德067000 [3]承德医学院附属医院小儿内科,河北承德067000

出　　处：《广东医学》2019年第10期1428-1432,共5页Guangdong Medical Journal

基　　金：承德市科学技术研究与发展计划项目(编号:201701A049)

摘　　要：目的探讨超声评估早产儿动脉导管未闭(PDA)对体循环影响的应用价值。方法选取出生3 d后确诊为PDA的早产儿140例为PDA组,随机抽取同期无PDA早产儿50例为对照组,均于出生后第3~4天行常规心脏及大脑中动脉(MCA)、肠系膜上动脉(SMA)和肾动脉(RA)彩色多普勒超声检查,测量其血流动力学参数,包括收缩期峰值流速(Vs)、舒张末期流速(Vd)、平均流速(Vm)、缩期峰值流速与舒张末期流速比值(S/D)、阻力指数(RI)及加速时间(AT)、加速度(AI);PDA组同时测量动脉导管内径和左肺动脉根部内径,计算二者比率(Rd),并据此将PDA组再分为大、中、小型动脉导管未闭3个组(L-PDA组、M-PDA组、S-PDA)。分别比较PDA组、PAD各分组与对照组间血流动力学参数的差异。结果 PDA组和L-PDA组,MCA、SMA和RA的Vd、Vm值均较对照组减低,S/D、RI值均较对照组增加,差异有统计学意义(P<0.05);M-PDA组,MCA和SMA的Vd、Vm值均较对照组减低,MCA和RA的S/D、RI值均较对照组增加,RA的Vd值均较对照组减低,差异均有统计学意义(P<0.05);各组的Vs、AT、AI值较对照组均差异无统计学意义(P>0.05);S-PDA组各参数较对照组均差异无统计学意义(P>0.05)。MCA及RA各参数左右两侧间比较差异无统计学意义(P>0.05);各组各血管S/D、RI值均与Rd呈正相关,其中RA的RI相关性最好,Vd、Vm值均与Rd呈负相关,RA的Vm相关性最好。结论超声可评估大、中型PDA早产儿体循环动力学改变,为临床判断和积极干预PDA提供依据;评估指标以Vd、Vm、S/D和RI为首选;PDA早产儿体循环血流改变与动脉导管内径有关,Rd值0.5可作为超声评价PDA早产儿体循环时区分PDA程度的临界参考值。Objective To evaluated the value of ultrasound in evaluating the influence of patent ductus arteriosus ( PDA) on systemic circulation for preterm infants. Methods A total of 140 preterm infants diagnosed with PDA 3 days after birth were selected as PDA group,and 50 preterm infants without PDA were randomly selected as control group. The color Doppler ultrasound examination was performed to study the hemodynamic parameters,including Vs,Vd,Vm,S /D, RI,AT and AI of MCA,SMA and RA on Day 3 or 4 of life. The diameter of arteriosus ductus and the diameter of left pul- monary artery root were measured at the same time in PDA group,and calculated the ratio between them. The PDA group were divided into 3 groups ( L - PDA,M - PDA and S - PDA) according to the ratio. The differences of hemodynamic pa- rameters among PDA,L - PDA,M - PDA and S - PDA groups and control group were compared. Results In PDA group and L - PDA group,the Vd and Vm of MCA,SMA,RA were significantly lower than those in control group,and the S / D and RI were significantly higher ( P < 0. 05). In M - PDA group,the Vd and Vm of MCA,SMA were significantly low- er than those in control group,S /D and RI of MCA,RA were significantly higher,and the Vd of RA were significantly lower ( P < 0. 05). There were no significant difference of Vs,AT and AI values among PDA,L - PDA,M - PDA group and control group. No significant difference in the all parameters observed in S - PDA group compared with the control group. No significant difference in the all parameters between the left and right sides of MCA and RA was observed. The S /D and RI values of MCA,SMA and RA in each group were proportional to Rd,among which the RI correlation of RA was the best. The Vd and Vm values of RA was inversely proportional to Rd,among which the Vm correlation of RA was the best. Conclusion Color Doppler ultrasound can detect the change of hemodynamic parameters of systemic circulation in preterm infants with large or medium type PDA,and provide the useful parameters in clinic. The Vd,

关 键 词：动脉导管未闭 早产儿 超声 血流动力学参数 

分 类 号：R445.1[医药卫生—影像医学与核医学] R722.6[医药卫生—诊断学]