Tei指数联合组织多普勒成像评价新生儿不同氧分压时的右心室功能

Tei index and tissue Doppler imaging for early identification of right ventricular function variations in neonates with different arterial oxygen pressure

目的探讨Tel指数及组织多普勒成像技术在评价新生儿不同氧分压时右心室功能变化中的作用。方法病例组61例新生儿均有围产期缺氧史合并呼吸系统疾病，根据生后1d的血氧分压（oxygen partial pressure，PaO2）分为A1组（PaO260-80mmHg，n=26）和A2组（PaO2≤60mmHg,n=35），另选无缺氧性疾病新生儿22例作为对照组。各组新生儿于生后1、3、7d采用超声心动图测肺动脉收缩压及右心室射血分数、三尖瓣口E／A值、右心室Tei指数、三尖瓣环组织多普勒成像指标（Sa、Aa、Ea、Ea／Aa值）。组间数据差异比较采用单因素方差分析，两两比较采用LSD-t检验。结果（1）A1组生后1d肺动脉收缩压为（47．13±7．95）mmHg，A2组为（75．52±12．24）mmHg，均较对照组[（24．64±8．78）mmHg]升高（P〈0．01）。（2）A2组生后1、3、7d右心室射血分数、E／A值较对照组降低（P〈0．01）。（3）A1组生后1、3dTei指数为0．54±0．07和0．54±0．11，A2组为0．72±0．09和0．71±0．08，均较对照组（0．40±0．07和0．38±0．09）升高（P〈0．01）。（4）A1及A2组生后1、3dEa和Ea／Aa值较对照组降低（P〈0．05）。结论右心室Tei指数及组织多普勒成像技术可发现新生儿不同氧分压时右心室功能的早期变化，可作为监测缺氧患儿右心室功能早期变化的简便、敏感的方法。

Objective To evaluate the role of Tei index and tissue Doppler imaging （TDI） in assessing right ventricular function of neonates with different arterial oxygen pressure （PaO2）. Methods According to the PaO2 level at 1 d after birth, 61 neonates with history of perinatal hypoxia associated with respiratory diseases were divided into A1 group（PaO2 60-80 mm Hg, n = 26）and A2 group（PaO2≤60 mm Hg,n=35）, 22 cases without hypoxia related diseases were as control group. On 1, 3 and 7 days after birth, echocardiography were performed to estimate pulmonary arterial systolic pressure （PASP） and right ventricular ejection fraction （RVEF） and E/A value and Tei index of right ventricle （RV-Tei）. Systolic wave of ventricular （Sa） and diastolic wave （Ea and Aa） were also measured and Ea/Aa value were calculated by TDI. One-way ANOVA served as the statistical method. Results In A1 and A2 group,PASP were （47.13±7.95） mm Hg and （75.52±12.24） mm Hg, significantly higher than that of the control group [（24.64±8. 78） mm Hg] on 1 day after birth （P〈0.01）. RVEF and E/A values of A2 group were lower than those of the control group （P〈 0.01）. On 1 and 3 days after birth, RV-Tei were 0.54±0.07 and 0.54±0.11 in A1 group, and 0.72±0.09 and 0.71±0.08 in A2 group. Both were higher than those of the control group （0.40±0.07 and 0. 38±0. 09） （P〈0.01）. Ea and Ea/Aa value in group A1 and A2 became lower on 1 and 3 days after birth than those of the control group （P〈0.05）. Conclusions RV-Tei and TDI is a simple and sensitive method to detect early changes of right ventricular function of hypoxic newborns.