七日龄内早产儿多普勒超声心动图参考范围的建立

Reference ranges for Doppler echocardiographic measurements within seven days of age in preterm infants

目的:基于不同出生胎龄、体重和体表面积建立0~7日龄早产儿多普勒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日龄早产儿的多普勒超声心动图资料,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,按体表面积0.07~0.20 m^(2)分为14组。采用独立样本K-W检验比较不同出生胎龄、出生体重和体表面积的多普勒超声心动图测量值,根据不同出生胎龄、体重和体表面积建立早产儿多普勒超声心动图参数的95%CI。结果:489例早产儿中男264例、女225例,出生胎龄32.0(30.0,33.9)周,出生体重1700(1260,2040)g,体表面积0.13(0.11,0.15)m^(2)。出生胎龄、出生体重和体表面积分别与主动脉瓣流速(AV)、二尖瓣血流E峰(MV-E)、二尖瓣血流E/A(MV-E/A)及三尖瓣血流E峰呈正相关(r=0.263、0.256、0.324、0.114,0.292、0.261、0.281、0.135和0.287、0.268、0.312、0.140,均P<0.05)。7日龄内的早产儿出生胎龄、出生体重和体表面积越大,AV、MV-E、MV-E/A和肺动脉瓣流速越大(均P<0.05)。4组不同出生胎龄早产儿AV、MV-E和MV-E/A的95%CI分别为48~54、52~57、58~63、60~65 cm/s,32~37、33~36、39~42、40~45 cm/s,0.66~0.73、0.74~0.80、0.81~0.90、0.92~1.06。5组不同出生体重早产儿AV、MV-E和MV-E/A的95%CI分别为45~53、49~53、59~64、60~66、56~65 cm/s,29~35、32~36、38~41、40~44、38~46 cm/s,0.65~0.74、0.74~0.81、0.81~0.99、0.86~0.99、0.84~1.07。结论:根据出生胎龄、体重和体表面积建立的多普勒超声心动图参数的95%CI可为0~7日龄早产儿提供可靠的参考范围。

Objective To establish reference ranges for Doppler echocardiography in preterm infants within 7 days after birth based on different gestational age(GA),birth weight(BW)and body surface area(BSA).Methods This retrospective study analyzed Doppler echocardiographic measurements 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^(+6) weeks,32-33^(+6) weeks and 34-36^(+6) weeks;and five groups according to BW:<1000 g,1000-1499 g,1500-1999 g,2000-2499 g and≥2500 g;and 14 groups according to BSA from 0.07-0.20 m^(2).The Doppler values among groups were compared by independent sample KW test,and based on which,the 95%CI were established as reference ranges.Results Among the 489 preterm infants,males were 264 and females were 225.Their GA,BW and BSA were 32.0(30.0,33.9)weeks,1700(1260,2040)g and 0.13(0.11,0.15)m^(2),respectively.Measurements are presented charting as 95%CI with respect to GA,BW and BSA for preterm infants aged 0-7 days.Aortic valve(AV)flow rate,mitral valve E peak(MV-E),mitral valve E/A(MV-E/A)and tricuspid valve E peak(TV-E)were all correlated with GA,BW and BSA(r=0.263,0.256,0.324 and 0.114 for GA;0.292,0.261,0.281 and 0.135 for BW;0.287,0.268,0.312 and 0.140 for BSA,all P<0.05).Within the first 7 days after birth,the greater the GA,birth weight and BSA,the greater the AV,MV-E,MV-E/A and pulmonary valve flow rate(all P<0.05).According to the above grouping of GA,the 95%CI of AV were 48-54,52-57,58-63 and 60-65 cm/s,respectively;and the 95%CI of MV-E were 32-37,33-36,39-42 and 40-45 cm/s,respectively;and the 95%CI of MV-E/A were 0.66-0.73,0.74-0.80,0.81-0.90 and 0.92-1.06.And according to the above grouping of BW,the 95%CI of AV were 45-53,49-53,59-64,60-66 and 56-65 cm/s,respectively;95%CI of MV-E were 29-35,32-36,38-41,40-44 and 38-46 cm/s,respectively;95%CI of MV-E/A were 0.65-0.74,0.74-0.81,0.81-0.99,0.86-0.99 and 0.84-1.07.Conclusion The 95%CI of Doppler echocardiographic measurements established based on GA,BW and BSA could provide a reference for preterm infants aged 0-7 days.