缺氧性肺动脉高压新生儿右心室功能与血气改变相关性研究

Correlation between right ventricular function and the indexes of blood gas in neonates with hypoxic pulmonary hypertension

目的探讨缺氧性肺动脉高压(HPH)新生儿右心室功能与血气分析指标的关系。方法对67例HPH患儿(轻度29例、中度23例、重度15例)及22例胎龄、体重与HPH组相近的非HPH患儿(对照组)于生后1d、3d、7d超声心动图测肺动脉收缩压(PASP),组织多普勒成像测三尖瓣环指标(Sa、Ea、Aa、Ea/Aa值),作血气分析记录血氧分压(PaO2)、吸入氧浓度(FiO2)、PaO2/FiO2。结果 1)生后1d:HPH组患儿PaO2、PaO2/FiO2降低,PASP升高(均P<0.01);Ea、Ea/Aa比值降低(P<0.05);中、重度组Sa值降低(P<0.05);中度组Aa值升高,而重度组Aa值降低(P<0.05);2)生后3d:轻、中度组PaO2、PaO2/FiO2恢复正常,余指标均未改变;3)生后7d:轻度组各指标均恢复正常;中度组除Ea、Ea/Aa比值仍低(P<0.05),余指标均恢复正常;重度组仅仅PaO2、PaO2/FiO2恢复正常。结论 HPH患儿心脏舒缩功能的改变及恢复和缺氧症状及PASP不完全平行。超声监测其PASP及右心室功能有助于指导临床诊治。

Objective To evaluate the relationship of right ventricular function with the indexes of blood gas in neonates with hypoxic pulmonary hypertension（HPH）.Methods Sixty-seven neonates with HPH（29 mild,23 moderate and 15 severe）and 22 gestational age-and weight-matched neonates without HPH（control group）were enrolled.On postnatal days 1,3 and 7,pulmonary artery systolic pressure（PASP）was measured by pulsed Doppler echocardiography.Systolic wave of ventricular（Sa）,early diastolic wave（Ea）,late diastolic wave（Aa）,and Ea/Aa ratio were determined by the tissue Doppler imaging（TDI）technology.Artery oxygen pressure（PaO2）,fractional concentration of inspired oxygen（FiO2）,and PaO2/ FiO2 ratio were simultaneously observed.Results On postnatal day 1,PaO2 and PaO2/FiO2 ratio as well as Ea and Ea/Aa ratio were significantly lower,while PASP was significantly higher in the HPH groups than those in the control group.Sa decreased in the moderate and severe HPH groups,Aa increased in the moderate HPH group,and Aa decreased significantly in the severe HPH group compared with that in the control group.On postnatal day 3,PaO2 and PaO2/FiO2 ratio returned to normal level in the mild and moderate HPH groups,while other indexes remained abnormal.On postnatal day 7,all the indexes above returned to normal level in the mild HPH group;Ea and Ea/Aa ratio were still significantly lower in the moderate HPH group,and the other indexes returned to normal level;in the severe HPH group,only PaO2 and PaO2/FiO2 ratio returned to normal level.Conclusions The changes and recovery of diastolic and systolic functions of right ventricular are not paralleled with hypoxia and PASP in neonates with HPH.It is helpful for the diagnosis and treatment of HPH by monitoring PASP and right ventricular function with TDI.