0~7日龄早产儿心脏M型超声心动图参考范围的建立

Reference ranges for M-mode echocardiographic measurements within seven days after birth in preterm infants

目的:基于不同出生胎龄和体重建立0~7日龄早产儿M型超声心动图的参考范围。方法:回顾性分析2017年3月至2020年2月北京大学第三医院儿科新生儿重症监护病房的489例0~7日龄早产儿的M型超声心动图资料,按出生胎龄分为<28周、28~31^+6周、32~33^+6周、34~36^+6周4组,按出生体重分为<1000 g、1000~1499 g、1500~1999 g、2000~2499 g、≥2500 g 5组。采用独立样本K-W检验比较不同出生胎龄、出生体重的超声心动图测量值,根据不同出生胎龄、出生体重建立早产儿M型超声心动图参数的95%置信区间(CI)和Z评分参考范围。结果:489例早产儿出生胎龄32.0(24.0~36.7)周,出生体重1700(650~3180 g);出生胎龄和出生体重均与室间隔厚度(IVSd)、舒张末期左室后壁厚度(LVPWd)、左房前后径(LAD)、左室舒张末内径(LVED)、左室收缩末内径(LVES)、右室流出道内径(RVOT)、舒张末期右室前后径(RVED)有相关性(r=0.209、0.216、0.430、0.608、0.495、0.464、0.447和0.275、0.288、0.445、0.609、0.496、0.499、0.464,P均<0.01),与左室射血分数(LVEF)、左室短轴缩短率(LVFS)均无相关性(P均>0.05)。7日龄内的早产儿,出生胎龄和体重越大心脏内径和室壁厚度越大(P均<0.01)。早产儿7日龄内LVEF、LVFS维持在较高而稳定的范围(95%CI:67%~69%、34%~36%)。结论:根据不同出生胎龄和出生体重建立了0~7日龄早产儿心脏内径、室间隔和左室壁厚度参考数据。根据出生胎龄和出生体重建立的M型超声心动图参数的95%CI和Z评分范围可为0~7日龄早产儿提供可靠的参考范围。

Objective To establish reference ranges for M-mode echocardiography in preterm infants within 7 days after birth based on different gestational age(GA)and birth weight.Methods This retrospective study analyzed M-mode echocardiographic values of 489 premature infants,who were admitted to the neonatal intensive care unit of Department of Pediatrics,Peking University Third Hospital from March 2017 to February 2020.These infants were divided into four groups according to GA:<28 weeks,28-31^+6weeks,32-33^+6weeks and 34-36^+6weeks;and five groups according to birth weight:<1000 g,1000-1499 g,1500-1999 g,2000-2499 g and≥2500 g.The M-mode values among groups were compared by independent sample K-W test,and based on which,the 95%confidence interval(CI)and the Z-value reference ranges were established.Results The gestational age of these infants was 32.0(24.0-36.7)weeks,and the birth weight was 1700(650-3180)g.The interventricular septum end-diastolic thickness(IVSd),left ventricular posterior wall end-diastolic thickness(LVPWd),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVED),left ventricular end-systolic diameter(LVES),right ventricular outflow tract(RVOT)and the right ventricular end-diastolic diameter(RVED),were all correlated with GA and birth weight(r=0.209,0.216,0.430,0.608,0.495,0.464,0.447;r=0.275,0.288,0.445,0.609,0.496,0.499,0.464;all P<0.01).While the left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)had no correlation with GA or birth weight(all P<0.05).Within the first 7 days after birth,the greater the GA and birth weight,the greater the inner diameters of the heart chambers,and the thicker the ventricular wall.The LVEF and LVFS maintained a high and stable level within the first week of life(95%CI:67%-69%,34%-36%).Conclusions According to different GA and birth weight,the reference ranges for chamber diameters,interventricular septal thickness and left ventricular wall thickness within 7 days were established.The 95%CI and Z score ranges for M-mode echocardiographic measurements established based on gestational age and birth weight can provide a reliable reference for preterm infants aged 0-7 days.