彩色多普勒超声动态监测窒息新生儿肾动脉主干血流动力学的意义

Color Doppler Ultrasound in Monitoring Hemodynamic Changes of Renal Artery in Neonatal Asphyxia

目的探讨彩色多普勒超声动态监测窒息新生儿肾动脉主干血流动力学改变的临床意义。资料与方法 60例窒息新生儿根据出生后1 min Apgar评分分为轻度窒息组(38例)和重度窒息组(22例),采用彩色多普勒超声监测窒息新生儿出生后第1天及第3天肾动脉主干收缩期峰值流速(Vs)、舒张末期流速(Vd)、阻力指数(RI)及尿内皮素-1(ET-1)水平。以同期20例健康足月新生儿作为对照。结果出生后第1天,轻度窒息组及重度窒息组患儿肾动脉主干血流Vs、Vd均较对照组降低、RI增大(P<0.05),重度窒息组变化更显著(P<0.05);出生后第3天,轻度窒息组及重度窒息组患儿肾动脉主干血流Vs、Vd较第1天下降,RI较第1天增大,且重度窒息组Vd及RI变化更显著(P<0.01)。轻度窒息组及重度窒息组患儿出生后第1天、第3天尿ET-1水平均较对照组增高(P<0.01),且重度窒息组升高更显著(P<0.05)。轻度窒息组及重度窒息组患儿第1天、第3天肾动脉主干血流Vs、Vd与尿ET-1水平均呈显著负相关(r=-0.823、-0.845,P<0.01),RI与尿ET-1水平呈显著正相关(r=0.785,P<0.01)。结论彩色多普勒超声监测新生儿肾动脉主干血流动力学改变与尿ET-1检测均可以动态、无创地反映窒息新生儿肾损伤的程度。

Purpose To explore the clinical value of color Doppler ultrasound in monitoring hemodynamic changes in main renal artery of neonatal asphyxia. Materials and Methods A total of 60 cases of neonatal asphyxia were divided into mild asphyxia （38 cases） and severe asphyxia （22 cases） according to Apgar score 1 min after born. Then the peak systolic velocity （Vs）, the end diastolic velocity （Vd） and the resistance index （RI） of the main renal artery were obtained by color Doppler ultrasound on day 1 and day 3; the level of endothelin-1 （ET-1） was also recorded accordingly. The above results were compared with those of 20 cases of healthy full-term new born infants. Results On day I, Vs and Vd of the main renal artery in the groups with mild asphyxia and severe asphyxia were both lower than those in healthy group （P〈0.05）, but RI was higher （P〈0.05）, with more dramatic changes in the group with severe asphyxia （P〈0.05）. On day 3, Vs and Vd in the groups with mild asphyxia and severe asphyxia reduced compared with those oil day I, whilst RI was higher than that on day I. Vd and RI in the group with severe asphyxia changed more significantly （P〈0.01）. As to the value of ET-I, both groups with mild asphyxia and severe asphyxia showed higher level than healthy group （P〈0.01）. More dramatic increase appeared in the group with severe asphyxia （P〈0.05）. In the groups with mild asphyxia and severe asphyxia, the Vs and Vd of the main renal artery were negatively correlated with ET-I on day 1 and day 3 （r= --0.823, --0.845：P〈0.01 ）, while the RI was positively correlated with ET-1 （1~0.785, P〈0.01）. Conclusion Both color Doppler ultrasound imaging and neonatal urine ET-I test can reflect degree of renal injury alter neonatal asphyxia dynamically and noninvasively, which can be used to evaluate the injury severity.