先天性房间隔缺损对新生儿心脏结构和血流动力学的影响

Hemodynamic and Constitutional Changes of Congenital Antrum Septal Defect in Neonates

目的:通过检测先天性房间隔缺损(atrial septal defect,ASD)新生儿心脏结构和血流动力学的变化,探讨其对新生儿的潜在危害。方法:利用彩色多普勒超声心动图检测68例先天性房间隔缺损患儿与82例正常新生儿心脏各腔室的大小、肺动脉内压力、三尖瓣反流等。结果:进行心脏彩超检查的原因以心脏杂音、紫绀、宫内窘迫或新生儿窒息、呼吸急促、肺动脉瓣第二心音亢进最常见。房间隔缺损有房间隔水平存在异常分流但探测不到回声失落的无缺损型34例,回声失落直径<5mm的小缺损型21例,回声失落直径≥5mm的大缺损型13例。三种类型对室间隔、左心室、主动脉、左室后壁的影响差异无显著性,但对右心房、右心室、肺动脉的影响程度与缺损直径有显著正相关;只有大型房间隔缺损型导致左心房扩张;缺损和分流束的直径与肺动脉压力增高、三尖瓣反流率、反流面积也有显著正相关;但分流方向与缺损直径无关。结论:新生儿先天性ASD以轻型最多见,可导致新生儿心脏结构和血流动力学的异常改变。

Objective： Approaching the potential hazard of congenital antrum septal defect to neonates by detecting the constitutional and hemodynamic changes Methods： Investigated all chambers of the heart ; pulmonary artery pressure and tricuspid regurgitation in 68 congenital antrum septal defect and 82 normal neonates by colour Doppler echocardiography. Results： Their main cause to colour Doppler echocardiography were murmur, cyanosis, panting, asphyxia, feeding - difficulty, Loud pulmonary valve second heart sound. There were three types of ASD including 34 cases existing shunts but no defect; 21 echo drop - out diameter 〈 5 mm and 13 echo drop - out diameter ≥ 5 ram, . there were no significant difference in all groups on left ventricle, aorta, interventricular septum, posterior wall of left ventricle. But there were significant difference and positive relation in influence of defect diameter to right antrum , right ventricle, pulmonary altery. Only the ASD echo drop -out diameter ≥5 mm caused left antrum expansion. There were positive relations in defect or shunt diameter to pulmonary pressure, tricuspid regurgitation rate, regurgitation area. But there were no relation in shunt direction to defect diameter. Conclusion： The most common ASD in newborn was mild. The earlier clinical situation were not typical. ASD may caused structural and hemodynamic changes although asymptomatic in neonates.