小于胎龄儿肾血流参数特点的临床研究

Clinical research of characteristics of renal hemodynamic parameters in small for gestational age infants

目的探讨足月适于胎龄(AGA)儿、早产小于胎龄(SGA)儿、足月SGA儿间肾血流参数的关系。方法采用彩色多普勒超声技术监测66名AGA儿、48例早产AGA儿、56例早产SGA儿、44例足月SGA儿生后第1、3、7天肾动脉血流动力学参数(收缩期峰值流速、舒张末期流速、阻力指数、搏动指数)变化。结果足月AGA儿阻力指数(RI)、搏动指数(PI)较早产AGA儿低(P<0.01);而收缩期峰值流速(PSFV)、舒张末期流速(EDFV)则高于AGA儿。与足月AGA儿比较,足月SGA儿的PSFV、EDFV在日龄第1、3、7天均显著减低(P<0.01,P<0.05),而其RI则增高(P<0.05),其差异有统计学意义。与早产SGA儿相比,足月SGA儿的PSFV在日龄第1、3天显著减低(P<0.01,P<0.05),而RI则显著增高(P<0.01,P<0.05),其差异有统计学意义;在第7日龄足月SGA儿的PSFV、EDFV均减低,RI、PI均增高,但差异无统计学意义(P>0.05)。结论SGA儿存在肾动脉血流动力学改变,表现为肾血流灌注不良,其相关因素有早产、低出生体重,尤低出生体重影响更明显。

Objective To study the relationships of renal hemodynamic parameters among term infant appropriate for gestational age（AGA）,preterm infant small for gestational age（SGA） and full term SGA infant.Methods Color Doppler Imaging（CDI） technique was used to monitor the changes of hemodynamic parameters（PSFV,EDFV,RI and PI） of renal main artery at day 1,3 and 7 after birth of 66 healthy full term AGA infants,48 AGA preterm infants,56 SGA preterm infants and 44 full term SGA infants.Results The levels of PI and RI of the renal main artery in full term AGA infants were significantly lower than that in preterm AGA infants （ P 〈 0.01 ） ; the levels of PSFV and EDFV were higher in full term AGA infants than that in preterm AGA infants. Compared with the full term AGA infants, the levels of PSFV and EDFV of the renal main artery in the full term SGA infants were significantly decreased （P 〈0. 01, P 〈0. 05） at 24 h, 72 h and 7 d after birth, the RI was significantly increased （P 〈 0. 05）. Meanwhile, compared with the preterm SGA infants, the levels of PSFV at 24 h and 3d after birth were significantly decreased in full term SGA infants （ P 〈 0.01 and P 〈 0. 05 respectively） ; but the RI value was significantly increased （P 〈 0. 01 and P 〈 0. 05 respectively） ; the levels of PSFV and EDFV of the full term SGA infants were decreased （ P 〉 0. 05 ） at day 7 after birth, the RI and PI values were increased （ P 〉 0. 05 ） which showed no statistical differences. Conclusions There are hemodynamic changes of the renal main artery in SGA infants which manifested insufficiency of the renal blood perfusion, and such findings are related to prematurity and low birth weight of infants, especially low birth weight.