早产新生儿心脏几何形态学和血流动力学的超声影像学评估

Echocardiographic Evaluation of Cardiac Geometric Morphology and Hemodynamics in Premature Infants

目的:探讨不同胎龄早产新生儿心脏几何形态学及血流动力学的超声心动图征象及影响因素。方法:本研究共纳入150例早产儿(试验组)和150例足月新生儿(对照组),以胎龄为界将试验组新生儿分为3个亚组即28~32^(+6)周亚组(n=48)、33~34^(+6)周亚组(n=56)和35~36^(+6)周亚组(n=46),对照组分为37~38^(+6)周亚组(n=80)和39~41^(+6)周亚组(n=70)。采用Philips iE33型彩包多普勒超声心动图诊断仪测量左心室舒张末期内径、左心室收缩末期内径、室间隔厚度、左心室后壁厚度、左心室舒张末期容积、左心室收缩末期容积、每搏输出量、左心室射血分数、左心室缩短分数及心输出量,并计算测算心搏指数及心脏指数、舒张期心肌质量、左心室质量指数(LVMI)、左心室相对厚度、左心室重构指数(LVRI)及舒张末期容积指数。结果:在体表面积校正后,各亚组的心脏几何形态学及血流动力学参数差异均无统计学意义(P>0.05)。日龄(P=0.001)、身长(P=0.001)及体重(低出生体重儿:P=0.012;正常出生体重儿:P=0.003;巨大儿:P=0.016)是新生儿LVMI的独立影响因素。人体测量学指标及基本的生命体征指标对新生儿LVRI的影响在各胎龄亚组问的差异无统计学意义(X^2=42.88,P=0.076),但对LVMI影响在各亚组间的差异有统计学意义(X^2=123.6,P<0.001)。结论:超声心动图评估早产儿心脏几何形态学和血流动力学指标对新生儿心脏的发育及成熟程度的评价具有重要临床意义。

Objective： To explore the echocardiographic cardiac geometric morphology and hemodynamics in premature infants at different gestational age with the inlfuencing factors. Methods： A total of 150 premature infants and 150 full-term control infants were enrolled in this study. Based on gestational age, premature infants were divided into 3 groups：①（28-32＋6 ） weeks,②（33-34＋6 ） weeks,③（35-36＋6） weeks; and full term control infants were divided into 2 groups：①’（37-38＋6） weeks and②’ （39-41＋6） weeks respectively. An iE33 Philips ultrasound examination was conducted to measure left ventricular end-diastolic diameter （LVEDD）, LVESD, interventricular septum thickness, posterior wall thickness, left ventricular end-diastolic volume （LVEDV）, LVESV, stroke volume, LVEF, left ventricular fractional shortening （LVFS）, cardiac output, stroke index, cardiac index, left ventricular mass, left ventricular mass index （LVMI）, left ventricular relative wall thickness, left ventricular remodeling index （LVRI） and LVEDVI. Results： With adjusted body surface area, all parameters for cardiac geometric morphology and hemodynamics were similar among different groups,P〉0.05. The day-old age （P=0.001）, height （P=0.001） and body weight for low nbsp;weight born infant （P=0.012）, for normal weight born infant （P=0.003）, for giant infant （P=0.016） were the independent inlfuencing factors for LVMI. The impact of anthropometry and the basic life indexes were similar on LVRI among groups （χ2=42.88,P=0.076）, while the covariates were different on LVMI among groups （χ2=123.6,P〈0.001）. Conclusion： Cardiac morphology and hemodynamics measured by echocardiography has important clinical meaning for assessing the development and maturity of neonatal hearts in premature infants.