超声心动图评价早产儿动脉导管关闭前后左心结构与功能变化

Echocardiogram in Evaluating Changes of Left Ventricular Structures and Functions Before and After Ductus Arteriosus Closure in Premature Infants

目的应用常规超声心动图和实时三维超声心动图(RT-3DE)评价早产儿动脉导管关闭前后左心结构与功能的变化。资料与方法选取出生72 h后动脉导管持续开放的早产儿60例,其中出生体重<1000 g的超低出生体重儿30例,出生体重1000~1500 g的极低出生体重儿30例。布洛芬治疗动脉导管关闭3~6 d后复查。用超声心动图测算患儿动脉导管关闭前后左心房内径(LAD)、左心室舒张末期内径(LVEDD)、二尖瓣舒张早期血流峰值速度(E)与舒张晚期血流峰值速度(A)比值(E/A)、二尖瓣环舒张早期运动峰值速度(E′)与舒张晚期运动峰值速度(A′)比值(E′/A′)、E/E′、Tei指数、左心室舒张末期容积(LVEDV)、左心室舒张末期容积指数(LVEDVI)、左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)以及左心室各节段射血分数。分析相关参数变化以及与动脉导管内径、分流速度的相关性。结果极低出生体重儿与超低出生体重儿组动脉导管关闭后LAD、LVEDD、E/E′、Tei指数、LVEDV、LVEDVI及LVMI明显减低(P<0.05),E/A、E′/A′明显增高(P<0.05);LVEF、左心室各节段射血分数无明显变化(P>0.05);两组患儿LAD、LVEDD、LVEDV与动脉导管内径呈正相关(r=0.574、0.642、0.661,P<0.05),LVMI与动脉导管分流速度呈正相关(r=0.264,P<0.05)。结论两组早产儿动脉导管关闭后左心内径缩小,左心室功能较闭合前改善。早产儿动脉导管内径、动脉导管分流速度是影响左心结构与功能的重要因素。

Purpose To evaluate the changes of left ventricular structures and functions before and after arterial catheter(DA)closure by conventional echocardiography and real-time three-dimensional echocardiography(RT-3DE)in premature infants.Materials and Methods Sixty premature infants in opening DA state 72 hours after birth were enrolled in this study,including 30 infants of ultra-low birth weight which were less than 1000 g and 30 infants of very-low birth weight which were 1000 to 1500 g.Rechecked 3 to 6 days after DA closure treated with ibuprofen.Measured left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),ratio of peak early diastolic flow velocity(E)and peak atrial diastolic flow velocity(A)(E/A),ratio of peak early diastolic motion velocity(E′)and peak atrial diastolic motion velocity(A′)(E′/A′),E/E′,Tei index,left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic volume index(LVEDVI),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF)and ejection fraction of each segment of the left ventricle with echocardiography before and after DA closure.Correlation between changes of relevant parameters and DA inner diameter and shunt velocity was analyzed.Results LAD,LVEDD,E/E′,Tei index,LVEDV,LVEDVI and LVMI in very-low body weight and ultra-low body weight group were significantly decreased(P<0.05),while E/A and E′/A′were remarkably enhanced(P<0.05).There was no obvious change regarding LVEF and ejection fraction of each segment of the left ventricle(P>0.05).LAD,LVEDD,LVEDV and DA inner diameter of infants in the two groups were positively correlated(r=0.574,0.642,0.661,P<0.05).There was a positive correlation between LVMI and DA shunt velocity(r=0.264,P<0.05).Conclusion After DA closure of premature infants in two groups,inner diameter of left ventricle is decreased and left ventricular function is improved compared with that before closure.DA inner diameter and DA shunt velocity in premature infants are important factors affecting left ventricular structures and functions.