新生儿窒息后Tei指数与血清心肌酶的关系

Relationship between Tei index and the myocardial enzymes in newborns after asphyxia

目的探讨新生儿窒息后Tei指数与血清心肌酶的关系。方法超声心动图测定44例轻度窒息新生儿、27例重度窒息新生儿及20例正常新生儿的二尖瓣口舒张期血流频谱E峰、A峰及E／A值、左心室射血分数、等容收缩间期、等容舒张间期及Tei指数，同时取其静脉血测定天冬氨酸氨基转移酶、肌酸激酶及其同工酶、乳酸脱氢酶、羟丁酸脱氢酶和肌钙蛋白T水平。组间差异比较采用单因素方差分析，两两比较用q检验，Tei指数与血清心肌酶间的关系采用直线相关分析。结果（1）Tel指数、等容收缩问期及等容舒张间期在重度窒息组分别为0．62±0．13、（47±7）ms和（52±8）ms，均高于轻度窒息组[分别为0．51±0．14、（41±6）ms和（43±6）ms]，轻度窒息组高于正常对照组[分别为0．39±0．12、（34±6）ms和（37±6）ms]，差异均有统计学意义（P均〈0．01）。（2）天冬氨酸氨基转移酶、肌酸激酶及其同工酶、乳酸脱氢酶、羟丁酸脱氢酶和肌钙蛋白T在轻度窒息组高于正常对照组（P〈0．01），重度窒息组高于轻度窒息组（P〈0．01）。（3）Tei指数、等容收缩间期及等容舒张间期均与血清心肌酶水平呈正相关（P〈0．01）。其中Tei指数与肌酸激酶及其同工酶和肌钙蛋白T相关性更明显（r分别为0．762、0．821、0．778，P均〈0．01）。结论Tei指数可与血清心肌酶联合应用，评价新生儿窒息后心肌损害患儿的心脏功能，更可准确和动态监测与评估心功能不全的程度。

Objective To study the relationship between Tei index and the myocardial enzymes in newborns with myocardial damage due to asphyxia. Methods Forty-four newborns with mild asphyxia, 27 newborns with severe asphyxia and 20 healthy newborns hospitalized in our hospital from January 2005 to December 2008 were enrolled in this study. The peak E and peak A and E/A ratio at mitral valve, the ejection fraction, isovolumetric contraction time, isovolumetric relaxation time and Tel index were measured by conventional echocardiography, and aspartate aminotransferase, creatine kinase, lactate dehydrogenase, hydroxybutyrate dehydrogenase and creatine phosphate kinase isoenzyme,and cardiac troponin T were tested also. One way ANOVA was used to analyze the difference between groups. Results Tei index, isovolumetric contraction time and isovolumetric relaxation time in the severe asphyxia newborns were 0.62 ± 0. 13, （47±7） ms and （52 ± 8） ms, higher than those in the mild asphyxia newborns[0.51± 0.14, （41v 6） ms and （43± 6） ms], those in the mild asphyxia newborns were higher than in the healthy newborns[0.39±0.12, （34±6） ms and （37±6 ） ms] （ all P 〈 0.01 ）. Aspartate aminotransferase, lactate dehydrogenase, hydroxybutyrate dehydrogenase, creatine kinase and its isoenzymes and cardiac troponin T in the severe asphyxia newborns were higher than in the mild asphyxia newborns and healthy group（P〈0.01）. Tei index, isovolumetric contraction time and isovolumetric relaxation time were positively related to the myocardial enzymes. The positive relationships were more statistically significant in Tel index, ereatine kinase, its isoenzymes and cardiac troponin T （r=0. 762, 0. 821, 0. 778, P〈0.01）. Conclusions Combination of Tei index and myocardial enzymes can not only be applied to assess the cardiac function in newborns with myocardial damage due to asphyxia, but also to evaluate the degree of cardiac dysfunction accurately and dynamically.