小儿先天性心脏病超声七步筛查法在极低出生体重儿动脉导管未闭诊疗中的应用  

Application of seven-step echocardiographic screening of congenital heart disease in predicting clinical outcome of very low birth weight infants with patent ductus arteriosus

作　　者：赵镭[1] 林慧佳[2] 俞劲[1] 钱晶晶[1] 傅行鹏 孟洁 张宝富 叶菁菁[1] ZHAO Lei;LIN Huijia;YU Jin;QIAN Jingjing;FU Xingpeng;MENG Jie;ZHANG Baofu;YE Jingjing(Department of Ultrasonography,Children's Hospital,Zhejiang University School of Medicine/National Clinical Research Center for Child Health,Hangzhou 310052,China;不详)

机构地区：[1]浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心超声科,杭州310052 [2]浙江大学医学院附属儿童医院/国家儿童健康与疾病临床医学研究中心新生儿重症监护室,杭州310052

出　　处：《浙江医学》2022年第20期2149-2153,共5页Zhejiang Medical Journal

基　　金：浙江省教育厅科研项目(Y201738496);浙江省医药卫生科技计划项目(2018KY454)。

摘　　要：目的探讨小儿先天性心脏病超声七步筛查法(简称先心七步法)在极低出生体重儿动脉导管未闭(PDA)诊断、预测转归中的价值。方法选取2020年11月至2021年9月浙江大学医学院附属儿童医院新生儿重症监护室收治的PDA极低出生体重儿52例为研究对象,均运用先心七步法行床边超声心动图检查,记录检查用时及出生后72 h超声相关指标。根据PDA临床转归,将患儿分为自然闭合组23例和临床干预组29例。比较两组患儿出生后72 h超声相关指标,采用多因素logistic回归分析(分别采用最优子集法和逐步回归法进行自变量筛选)影响极低出生体重儿PDA转归方向的超声相关指标。采用ROC曲线评估超声相关指标预测PDA临床转归的效能。结果先心七步法行床边超声检查极低出生体重儿,完成1次超声心动图检查用时少、诊断结果准确。自然闭合组PDA直径、PDA直径/体重、收缩期峰值流速与舒张末期流速比值、肺动脉收缩压均低于临床干预组,收缩期峰值流速、主-肺动脉压差均高于临床干预组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,PDA直径/体重具有独立预测早产儿PDA转归方向的价值(OR=5.398,95%CI:2.103~13.858,P<0.01)。ROC曲线显示直径/体重预测PDA临床转归的最佳临界值为3.015。结论先心七步法进行床边超声心动图检查规范、简单、准确,值得在基层医院推广应用。其超声相关指标,尤其是PDA直径/体重可预测极低出生体重儿PDA转归,为后续治疗策略制定提供依据。Objective To evaluate the application of seven-step echocardiographic screening of congenital heart disease(SSES for CHD)in the diagnosis and prediction of the patent ductus arteriosus(PDA) in very low birth weight infants(VLBWI). Methods Clinical data of 52 VLBWI with PDA admitted in Neonatal Intensive Care Unit of Children’s Hospital,Zhejiang University School of Medicine between November 2020 and September 2021 were retrospectively analyzed. The bedside SSES for CHD was performed for all these infants, the examination time and echocardiographic parameters at 72 h after birth were recorded. There were 23 infants whose PDA was closed naturally(natural closure group) and 29 infants whose PDA was closed after clinical intervention(clinical intervention group). Echocardiographic parameters at 72 h after birth were compared between two groups. Optimal subset method and stepwise regression method were used to screen independent variables and multivariate logistic analysis was performed to analyze factors for predicting the clinical outcomes of PDA infants. ROC curve was used to evaluate the efficacy of ultrasound indicators for prediction of PDA outcomes. Results The bedside ultrasonography with SSES for CHD took less time with accurate diagnosis in VLBWI. The PDA diameter, PDA diameter/body weight, the ratio of peak systolic velocity/end diastolic velocity, and pulmonary artery systolic pressure in the natural closure group were significantly lower than those in the clinical intervention group. And the peak systolic velocity and the difference between main and pulmonary artery pressure in natural closure group were significantly higher than those in the clinical intervention group(P<0.05). Multivariate logistic regression analysis showed that the diameter/weight of PDA was an independent predictor for outcomes of PDA in VLBW infants(OR=5.398, 95%CI:2.103-13.858, P<0.01). The ROC curve analysis showed that the cut-off value of PDA diameter/body weight was 3.015 for predicting the clinical outcome of PDA. Conclusion

关 键 词：极低出生体重儿 动脉导管未闭 超声心动图 先天性心脏病超声七步筛查法 

分 类 号：R725.4[医药卫生—儿科] R445.1[医药卫生—临床医学]