围产期窒息对新生儿心血管系统的损害(附50例分析)

CARDIOVASCULAR INJURIES DUE TO PERINATAL ASPHYXIA (ANALYSIS OF 50 CASES)

本文对50例围产窒息新生儿进行了前瞻性观察,以研究围产窒息对新生儿心血管系统的损害。50例中宫内窘迫5例,初生窒息40例,初生窒息伴宫内窘迫5例。轻度窒息14例,重度36例。初生8小时内做血气分析有低氧血症、代谢和呼吸性酸中毒。初生3天内做心电图,异常者占88％,以ST-T波改变最多见。初生3天内胸片示心脏扩大,心胸比平均值0.64±0.05。心肌酶谱检查GOT、LDH、CPK总酶和CPK-MB皆高于正常新生儿。7例合并动脉导管未闭,5例用消炎痛关闭,4例成功,1例无效。另2例初生1周后自行关闭。7例有心功能不全的表现。6例发生窦性心动过缓,心室率60～90次/分,2～3天恢复。死亡6例,5例死于肺、脑合并症,1例死于持续胎儿循环及休克。3例尸解有广泛性心肌空泡变性,2例有心室腔扩大,说明有严重心肌受损。对于窒息后心功能不全主张用多巴胺或多巴酚丁胺配合血管扩张药酚托拉明等治疗。

Fifty cases of perinatal asphyxia were followed closely after birth. Fourty cases suffered from birth asphyxia, five cases from intrauterine asphyxia, and five cases from both intrauterine and birth asphyxia. The asphyxia was mild in 14 cases and severe in 36 cases. Blood gas analysis done within 8 hours postnatally showed hypoximia, metabolic and res- piratory acidosis in 25/25 of the patients. ECG abnomalities, including ST-T segment depression, flat or inversive T-wave, ventricular hypertro- phy, premature ventricular contractions, abnomal Q-wave and A-V block. Chest radiograph demostrated cardiomagaly in 30/33 cases, the mean car- diothoratic ratio being 0.64±0.05. The echocardiogram discovered patent ductus arteriosus in seven cases, two of them closed spontanuously while four closed after indomethacin treatment and one failed to close after medication. Myocardial enzyme examination conformed elevation of GOT. LDK, and CPK-MB fraction. (absolute digit and percentage) Six cases had sinus bradycardia with a heart rate of 60-90/min and recovered wi- thin 2-3 days. One cases died of persistant fetal circulation and shock, five died of pulmonary and cerebral complications. Autopsy revealed ven- tricular dilatation in two cases and extensive vacuolar degeneration of the myocardial in three cases. Dopamine, dopatamine and phentolamine were all effective in improving the cardiac performence and so the heart fai- lure.