超声心动图预测小儿动脉导管自行关闭的价值

Echocardiography for prediction of spontaneous closure of patent ductus arteriosus in neonates and infants

目的探讨简易的超声心动图指标预测动脉导管开放(PDA)新生儿及婴儿日后动脉导管自行关闭的可能性及临床意义。方法对新生儿及婴儿期经彩色多普勒超声心动图证实的PDA患儿56例(其中早产儿8例,低出生体重儿18例)进行3、6、9和12个月随访观察,初诊年龄1-33(15.8±12.3)d。观察指标包括二维超声心动图测量的PDA最小直径(MD2DE),彩色多普勒血流显像测量的PDA分流束宽度(W JCDFI),并评估超声心动图指标对预测患儿1周岁时PDA自行关闭的价值。PDA关闭的判断标准为彩色多普勒血流显像无异常分流且频谱多普勒超声未能探及连续性分流频谱。结果随访过程中,随访3、6、9和12个月的PDA自行关闭率分别为23.2%、30.4%、32.1%和32.1%。若分别以首次测量的MD2DE≤3mm和≤2mm以及M JCDFI≤3mm和≤2mm为界限,则12个月随访结束时2种测量技术4项测量指标预测PDA关闭的敏感性为46.9%、80.0%、65.0%和83.3%(P<0.05),特异性为87.5%、94.4%、86.1%和81.9%(P<0.05),阳性预测值为83.3%、88.9%、72.2%和55.5%(P<0.05),阴性预测值为55.3%、89.5%、81.6%和81.8%(P<0.05),准确性为64.3%、89.3%、78.6%和82.1%(P<0.05)。结论简易超声心动图指标可较好地预测未闭动脉导管自行闭合的可能性,对患儿是否选择早期干预措施具有指导价值。

Objective To explore the ability of echocardiography for the prediction of spontaneous closure of patent ductus arteriosus （ PDA ） in neonates and infants and its clinical significance. Methods Fifty-six neonates and infants with PDA （8 premature infants, 18 low birthweight infants） , aged 15. 8 ± 12. 3 days, underwent follow-up by serial echocardiography examination every 3 months for one year. The minimal diameter of PDA （MD2DE） was measured by two-dimensional echocardiography （2DE） ,and the width of PDA shunting jet at its base （WJCDFI） assessed by color-coded flow imaging [CDFI）. The closure rate of PDA at every stage was indicated by CR3, CR6, CR9 and CR12, respectively. Results During one year follow-up,CR3,CR6,CR9 and CR12 was 23.2% ,30.4% ,32. 1% and 32. 1%, respectively. When four parameters from two techniques （MD2DE ≤3mm and ≤2mm,MJCDFI≤3mm and≤2mm） at the first measurement were used for prediction of spontaneous closure of PDA,the sensitivity was 46. 9% ,80. 0% ,65.0% and 83.3% （ P 〈 0.05）, specificity was 87.5% ,94. 4% ,86. 1% and 81.9% （ P 〈 0. 05）, positive prediction value was 83.3%, 88. 9% ,72.2% and 55.5% [ P 〈 0. 05 ） , negative prediction value was 55.3%, 89. 5%, 81.6% and 81.8% （ P 〈 0. 05 ） ,and accuracy was 64. 3% ,89. 3% ,78. 6% and 82. 1% （ P 〈0. 05 ）. Conclusion Simple echocardiographic parameters are capable of prediction of spontaneous closure of PDA in neonates and infants, and may help to decide whether early intervention is necessary.