超声心动图评价早产儿动脉导管未闭治疗前后左心室功能变化

Changes of Left Ventricular Functions Before and After Patent Ductus Arteriosus Treatment in Premature Infants by Echocardiography

目的超声心动图评价早产儿动脉导管未闭(PDA)经口服布洛芬治疗前后左心室功能的变化。资料与方法纳入胎龄<34周、临床确诊有血流动力学意义的PDA(hsPDA)且经口服布洛芬治疗的患儿50例,根据疗效分为导管闭合组37例和未闭组13例。观察两组患儿的一般情况,采用超声测量动脉导管(DA)直径、峰值分流速度、压差、左心室射血分数(LVEF)、左心房(LA)与主动脉根部(AO)比(LA/AO)、E/A及e'/a'比值。结果①与导管闭合组比较,未闭组患儿胎龄小、出生体重低、DA直径及LA/AO值大,峰值流速及压差低,差异有统计学意义(P<0.05)。②治疗后与治疗前比较:导管闭合组LA/AO减小,E/A、e'/a'升高,差异有统计学意义(P<0.05);未闭组DA直径减小,峰值流速及压差升高,差异有统计学意义(P<0.05),而E/A、e'/a'变化差异无统计学意义(P>0.05)。两组患儿治疗前后LVEF变化差异均无统计学意义(P>0.05)。结论早产儿hsPDA治疗闭合后,可改善其左心室舒张功能。

Purpose To evaluate the changes of left ventricular functions before and after patent ductus arteriosus(PDA)treatment in premature infants by echocardiography.Materials and Methods Fifty infants whose gestational age were less than 34 weeks and diagnosed as hemodynamic significance patent ductus artefiosus(hsPDA)and received oral ibuprofen treatment were included.The infants were divided into closed group(n=37)and unclosed group(n=13)according to efficacy.General situation of infants in the two groups was observed.Ultrasound was taken to measure diameter of arterial duct(DA),peak shunt velocity,differential pressure,left ventricular ejection fraction(LVEF),ratio of left atrial diameter(LA)and aortic root diameter(AO)(LA/AO),E/A ratio and e'/a'ratio.Results(1)Compared with the closed group,the gestational age was younger,birth mass was lower,DA diameter and LA/AO were greater,peak shunt velocity and differential pressure were lower in the unclosed group,with statistical difference(P<0.05).(2)After treatment,LA/AO in closed group was reduced and E/A and e’/a’were elevated than those before treatment,with statistical significance(P<0.05).DA diameter in unclosed group was decreased,peak shunt velocity and differential pressure were statistically increased(P<0.05).However,difference of E/A and e'/a'changes was of no statistical significance(P>0.05).There was no difference in LVEF changes before and after treatment for infants between the two groups(P>0.05).Conclusion After the treatment of hsPDA in premature infants,left ventricular diastolic functions could be improved.