超声心动图评价新生儿动脉导管自然闭合的临床价值  

The Clinical Value of Echocardiography in Evaluating the Spontaneous Closure of the Patent Ductus Arteriosus in Premature Infants

作　　者：詹自玉 郭薇[2] ZHAN Ziyu;GUO Wei(The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院,福建福州350005 [2]福建省立医院

出　　处：《中国医学创新》2021年第23期147-151,共5页Medical Innovation of China

摘　　要：目的:利用超声心动图评价动脉导管内径对新生儿心脏血流动力学的影响,并分析其预测早期动脉导管自然闭合的价值。方法:选取2017年10月-2019年10月本院72例出生24 h内超声心动图检查提示存在动脉导管未闭(PDA)的新生儿,利用超声心动图于肺动脉长轴切面测量PDA内径(DAD)/体表面积(BSA)、左心房收缩末期内径(LA)/主动脉根部内径(AO)、左心室舒张末期内径(LV)/AO、导管处分流速度及压差、肺动脉收缩压(PASP),对新生儿进行随访,在无药物及手术干预前提下,1周内动脉导管未闭者纳入PDA组,1周内动脉导管成功闭合者纳入自然闭合组。比较两组的各超声血流动力学参数差异,分析动脉导管内径与PASP、LA/AO,LV/AO、导管处分流速度及压差的相关性,并用ROC曲线分析超声心动图参数预测新生儿PDA自然闭合的价值。结果:PDA组的DAD/BSA、PASP、LA/AO、LV/AO均高于自然闭合组,差异均有统计学意义(P<0.05),动脉导管处分流速度及压差均低于自然闭合组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,DAD/BSA、PASP、LA/AO、LV/AO、导管处分流速度及压差预测PDA早期能否自然闭合的最佳临界值分别为19.45 mm/m^(2)、42 mmHg、1.56 、2.15、2.34 m/s、21.5 mmHg。相关性分析显示,动脉导管内径与PASP、LA/AO、LV/AO均呈正相关(r=0.66、0.77、0.36,P<0.05),DAD/BSA与导管处分流速度及压差呈负相关(r=-0.42、-0.46,P<0.05)。结论:动脉导管内径影响新生儿心脏血流动力学参数变化,并能够预测其早期动脉导管自然闭合的情况,有助于临床医生选择适宜的治疗时机。Objective:To evaluate the effect of ductus arteriosus diameter on neonatal cardiac hemodynamics and analyze its value in predicting early natural closure of ductus arteriosus.Method:A total of 72 infants with patent ductus arteriosus were enrolled in our hospital from October 2017 to October 2019.All the infants were accepted 2D echocardiography and color doppler echocardiography measurements including DAD/BSA,LA/AO,LV/AO,blood flow velocity and pressure at cathete,pulmonary artery pressure.They were divided into PDA group and spontaneous closure group according to whether spontaneous closure of the patent ductus or not within one week in the absence of drug and surgical intervention.Compared the difference of various hemodynamic parameters between the two groups,correlations between the diameter of the artery and the systolic pressure of pulmonary artery (PASP),LA/AO,LV/AO and blood flow velocity and pressure at catheter were analyzed,the value of parameters to predict the spontaneous closure of PDA in preterm infants was analyzed by ROC curve.Result:DAD/BSA,PASP,LA/AO,LV/AO in PDA group were higher than those in natural closure group,the differences were statistically significant (P<0.05);the shunt velocity and pressure difference at the ductus arteriosum were lower than those in the natural closure group,the differences were statistically significant (P<0.05).ROC curve analysis showed that,the optimal critical values of DAD/BSA,PASP,LA/AO,LV/AO,shunt velocity at the catheter and pressure difference for predicting the early natural closure of PDA were 19.45 mm/m^(2),42 mmHg,1.56,2.15,2.34 m/s and 21.5 mmHg,respectively.The correlation analysis showed that the internal diameter of the ductus arteriosus was positively correlated with PASP 、 LA/AO and LV/AO (r=0.66,0.77,0.36,P<0.05).There were negative correlations between blood flow velocity and pressure at cathete and DSA/BSA (r=-0.42,-0.46,P<0.05).Conclusion:The inner diameter of the ductus arteriosus affects the changes of cardiac hemodynamic parameters and

关 键 词：超声心动图 新生儿 动脉导管未闭 闭合 

分 类 号：R722.1[医药卫生—儿科] R540.45[医药卫生—临床医学]