Tei指数在新生儿窒息后心肌损害的诊断及治疗中的价值

Value of Doppler Tei Index in Diagnosis and Treatment of Hypoxic Cardiac Damage in Newborns

目的探讨Tei指数在新生儿窒息后心肌损害的诊断及治疗中的临床意义。方法选择正常足月新生儿60例(正常对照组)、重度窒息和轻度窒息后心肌损害足月新生儿(重度窒息组、轻度窒息组,各40例),对3组新生儿在生后24～48h内、窒息心肌损害新生儿治疗1周后行常规超声心动图检查并同步描记心电图,分别测量左室射血分数(EF)及左、右心室舒张早期最大血流速度(E峰)、舒张晚期最大血流速度(A峰)及E/A比值、等容舒张时间(IRT)、等容收缩时间(ICT)、射血时间(ET)、Tei指数。比较3组新生儿上述各项心功能指标。对窒息后心肌损害新生儿同时作血清CK-MB测定并与Tei指数做相关性分析。对窒息后心肌损害患儿经规范治疗1周后重测以上部分指标,并对其治疗前后进行比较。结果 3组间左室EF及左、右心室E峰、A峰及E/A比较差异均无统计学意义(均P>0.05)。重度窒息组与正常对照组相比,Tei指数、IRT、ICT明显增高(P<0.01),ET明显降低(P<0.05);重度窒息组与轻度窒息组相比,Tei指数、IRT、ICT明显增高(P<0.01),ET的差异无统计学意义(P>0.05);轻度窒息组与正常对照组相比,Tei指数、IRT、ICT明显增高(P<0.01),ET明显降低(P<0.05)。窒息并心肌损害新生儿生后24～48h血清CK-MB与左、右心室Tei指数呈正相关(r=0.787、r=0.773,均P<0.01)。窒息并心肌损害患儿经规范治疗1周后与治疗前比较,Tei指数、ICT、IRT及CK-MB均明显下降(均P<0.01),ET明显上升(P<0.01)。结论 Tei指数能快速、准确地评价新生儿窒息后心肌损害的心脏功能。

Objective To assess the cardiac function in newborns with hypoxic cardiac damage using Doppler Tei index.Methods Echocardiograms were performed to measure left ventricular ejection fraction（EF）,left and right ventricular Tei index,isovolumic relaxation time（IRT）,isovolumic contraction time（ICT）,ejection time（ET）,peak velocities of early（peak E） and late（peak A） filling,and E/A ratio in 60 normal full term newborns,40 gestational age infants with serious asphyxia and 40 gestational age infants with light asphyxia.Cardiac function indexes were compared among the three groups of infants.In addition,serum CK-MB was determined and its correlation with Tei index was analyzed before and after treatment for 1 week.Results There were no significant differences in EF,peak E,peak A and E/A ratio among the three groups of infants（P0.05）.Compared with normal control group,both serious and light asphyxia significantly increased Tei index,IRT and ICT,but obviously decreased ET（P0.01）.Compared with light asphyxia group,Tei index,IRT and ICT markedly increased in serious asphyxia group,but no significant differences in ET were observed between the two groups（P0.05）.Futhermore,there was a positive correlation between CK-MB and left and right ventricular Tei index（r=0.787 and 0.773,respectively;P0.01）.After treatment for 1 week,CK-MB,Tei index,IRT and ICT obviously decreased but ET significantly increased compared with the values measured before treatment（P0.01）.Conclusion Tei index is a valuable and sensitive index for estimating cardiac function in newborns with hypoxic cardiac damage.