新生儿窒息后心功能变化及其与心肌肌钙蛋白的关系

The alteration of cardiac function after neonatal asphyxia and its relationship with cardiac troponin

目的探讨新生儿不同程度窒息后心功能的变化及其与血清心肌肌钙蛋白(cTnI)关系。方法足月新生儿窒息组62例(轻度窒息、重度窒息各31例)和对照组30例分别于生后24h内抽血测cTnI,并应用多普勒超声心动图测定其左室射血分数(LVEF)、左室短轴缩短率(FS)、每搏量(SV)及左房室瓣E峰、A峰及其比值(EV/AV)。结果重度组cTnI水平显著高于轻度组、对照组(P<0.01),LVEF、FS明显低于对照组,并cTnI与LVEF、FS呈负相关;SV、E、A和EV/AV3组比较差异均无统计学意义。结论重度窒息新生儿早期心脏收缩功能明显减退,心脏收缩功能减退与心肌细胞的损害密切相关。

Objective To observe the alteration of cardiac function after neonatal asphyxia and its relationship with cardiac treponin （cTnI）. Methods Sixty two cases of full-lerm newborn asphyxia （including 31 light cases and 31 severe cases）, and 30 cases of control were recruited in the study. Venous blood samples were drawn within 24h after delivery and the serum cTnI levels were determined. Doppler echoeardiography was applied to measure Left ventricle ejection fraction （LVEF）, left ventricle shortening fraction （FS）, stroke volume （SV）, and the peak early-diastolic velocity （E）, the peak late-diastolic velocity （A） and the ratio of the left atrioventricular valve （EV/AV）. Results Serum cTnI levels in the severe group were significantly higher than those in the light group or in control group （P〈0.01）; LVEF and FS were significantly lower than those in control group （P〈0.05）, which were negatively correlated with serum cTnI levels （r=-0.67 and 0.75 respectively, both P 〈 0.05）. There were no significant differences of SV, E, A and EV/AV among three groups （ all P 〉 0.05 ）. Conclusion The systolic function decrease in the early phase of severe neonatal asphyxia is closely related to the damage of myocardial cells. Key words： neonatal asphyxia, left ventricle ejection fraction, left ventricle shortening fraction, streke vol- ume, EV/AV of left atrioventricular valve, cardiac troponin （cTnl）