新生儿窒息后左心室扭转功能与血清心肌酶关系的初步研究

Relationship between twist function of left ventricle and myocardial enzymes in newborns after asphyxia

目的 探讨新生儿窒息后左心室扭转功能与血清心肌酶的关系.方法 应用超声速度向量成像（VVI）技术测定30例轻度窒息新生儿、20例重度窒息新生儿及50例正常足月新生儿的左心室心尖旋转、左心室心底旋转、左心室扭转、左心室扭力.同时取其静脉血测定肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）水平.结果 （1）左心室心底旋转在正常组、轻度窒息组和重度窒息组间差异无统计学意义 （P ＞0.05）.（2）左心室心尖旋转、左心室扭转、左心室扭力在重度窒息组分别为（1.251±0.877）°、（0.427±0.135）°、（0.018±0.010） °/mm,明显低于轻度窒息组[分别为（1.849±0.878）°、（1.244±0.456）°、（0.045±0.018）°/mm],轻度窒息组低于正常对照组[分别为（3.193±1.132）°、（1.698±1.010）°、（0.061±0.036） °/mm],差异均有统计学意义（均P＜0.01）.（3）CK-MB、cTnI在轻度窒息组高于正常对照组,重度窒息组高于轻度窒息组（均P＜0.01）.（4）左心室心尖旋转、左心室扭转及左心室扭力与血清心肌酶水平呈负相关（P＜0.01或0.05）,其中左心室扭转与cTnI相关性最显著.结论 窒息后新生儿左心室扭转功能明显下降,可与血清心肌酶联合应用,客观评价窒息后足月新生儿左心室功能,动态监测,指导临床工作.

Objective To investigate the relationship between twist function of left ventricle and myocardial enzymes in newborns with myocardial damage due to asphyxia.Methods Thirty newborns with mild asphyxia,20 newborns with severe asphyxia and 50 healthy newborns were enrolled in this study. The apical and basal rotation, the left ventricuiar twist and left ventricular torsion were measured by echocardiography velocity vector imaging, and creatine kinase isoenzyme, cardiac troponin I were also measured. One-way ANOVA was used to analyze the difference between groups.Results There was no difference in basal rotation among three groups. The apical rotation, left ventricular twist and left ventricular torsion in the severe asphyxia newborns were （1.251 ± 0.877）° , （0.427 ± 0.135）° and （0.018 ± 0.010）° /mm, lower than those in the mild asphyxia newborns [ （1.849 ± 0.878）° , （1.244 ± 0.456）° and （0.045 ± 0.018）° /mm]; and those in the mild asphyxia newborns were lower than in the healthy newborns [（3.193 ± 1.132）° , （1.698 ± 1.010）° and （0.061 ± 0.036） ° /mm]（all P〈0.01 ）. Creatine kinase isoenzyme, cardiac troponin I in sever asphyxia newborns were higher than those in mild asphyxia newborns and healthy group （P〈0.01）. The apical rotation, left ventricular twist and left ventricular torsion were negatively correlated with the myocardial enzymes, particularly for left ventricular twist with cardiac troponin I （P〈0.01 or 0.05）. Conclusion Combination of left ventricular twist function and myocardial enzymes can be applied to assess the left ventricular function accurately and dynamically in newborns with myocardial damage due to asphyxia.