心导管及多普勒超声评价正常新生儿肺动脉压力的研究进展

Development of application of catheterization and Doppler ultrasound in assessing pulmonary artery pressure in newborns

新生儿肺动脉压力高于正常成年人,公认的主要原因是由于新生儿肺血管阻力变化形成的.对这一时期肺动脉压力的定量评价中,心导管研究显示：生后lh平均肺动脉压力等于或者超过体循环压力,之后逐渐下降,下降最明显的阶段发生在生后的24 h内,出生后3d,平均肺动脉压力小于体循环压力的一半.多普勒超声心动图对这一下降过程的研究得到了相似的结果,而且通过三尖瓣反流和动脉导管得到的肺动脉压力的结果的可重复性最佳.该文主要阐述心导管和多普勒超声心动图定量评价正常足月新生儿出生后肺动脉压力的变化情况,以期为临床鉴别新生儿是否存在肺动脉高压提供依据.

It is well established that pulmonary vascular resistance plays a pivotal role in the postnatal decrease of pulmonary arterial pressure in neonates. Catheterization has been demonstrated that mean pulmonary arterial pressure（PAP） equals or exceeds systemic for as long as I hour after birth. Thereafter, a gradual decrease in pressure occurs with the major fall taking place during the first 24 hours. By 3 days of age, the mean pulmona- ry arterial pressure is less than 50 per cent of that in the systemic circulation. Tricuspid regurgitation（TR） and ductal flow velocity（PDA） have the largest number of confidence steps in the expected range of values. The most repeatable technique is TR, but PDA might also be useful for a serial studies owing to the potential for large change. This paper reviews the PAP of normal full-term infants after birth by catheterization and Doppler ultra- sound, in order to provide some clinic basis for pulmonary hypertension identification.