心肌做功参数对轻度窒息新生儿心肌损伤的早期识别作用

The role of myocardial work parameters in early identification of myocardial injury in neonatal asphyxia

目的:探讨心肌做功参数对轻度窒息新生儿心肌损伤的早期识别作用。方法:选择2020年7月至2021年12月出生24 h内收入苏州大学附属儿童医院新生儿科并诊断为轻度窒息的患儿为轻度窒息组,根据胎龄分为早产儿轻度窒息组、足月儿轻度窒息组,按1∶1~1∶2的比例选取同期出生24 h内因低出生体重儿、试管婴儿、新生儿肺炎(无呼吸衰竭、未应用机械通气)等原因入院且性别、胎龄和出生体重与轻度窒息组匹配的新生儿为对照组,进行前瞻性研究。入选患儿均于生后24 h内进行超声心动图检查,测量M型、二维、多普勒等常规指标,以及左室整体纵向应变(global longitudinal strain,GLS)、整体做功指数(global work index,GWI)、整体有效做功(global constructive work,GCW)、整体无效做功(global wasted work,GWW)、整体做功效率(global work efficiency,GWE)等心肌做功参数,记录轻度窒息组患儿血清脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)水平。比较轻度窒息组与对照组各指标的差异,分析心肌做功参数与其他指标间的相关性。结果:共纳入轻度窒息组33例,对照组43例。早产儿轻度窒息组(18例)GWI和GCW低于早产儿对照组(18例)[(702±153)mmHg比(879±205)mmHg,(1016±221)mmHg比(1200±271)mmHg],差异有统计学意义(P<0.05),两组GLS、GWW和GWE差异无统计学意义(P>0.05);足月儿轻度窒息组(15例)GWW低于足月儿对照组(25例)[45.0(30.0,65.0)mmHg比71.0(35.5,85.5)mmHg],差异有统计学意义(P<0.05),两组GLS、GWI、GCW和GWE差异无统计学意义(P>0.05)。GWI与NT-proBNP水平呈负相关(r=-0.327,P<0.05)。结论:心肌做功参数GWI、GCW有助于早期识别轻度窒息早产儿的心肌损伤。

Objective To study the role of myocardial work parameters in early identification of myocardial injury in neonatal asphyxia.MethodsFrom July 2020 to December 2021,neonates diagnosed with mild neonatal asphyxia admitted to the Department of Neonatology of our hospital within 24 h after birth were prospectively enrolled into the asphyxia group.Neonates without asphyxia during the same period were selected as the control group and matched with the asphyxia group for gender,gestational age and birth weight at a ratio of 1:1~1:2.The asphyxia group was subgrouped into preterm asphyxia group and term asphyxia group.All neonates received echocardiography within 24 h after birth.Multiple parameters were measured including M-mode,two-dimensional image,Doppler image,global longitudinal strain(GLS)and myocardial work parameters[global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE)].The level of serum N-terminal pro brain natriuretic peptide(NT-proBNP)was recorded in the asphyxia group.The data were compared between the asphyxia group and the control group.Correlations between myocardial work parameters and other parameters were analyzed.ResultsA total of 33 cases were in the asphyxia group and 43 cases were in the control group.The preterm asphyxia group(18 cases)showed significantly lower GWI and GCW than the preterm control group(18 cases)[GWI:(702±153)mmHg vs.(879±205)mmHg,GCW:(1016±221)mmHg vs.(1200±271)mmHg](P<0.05).No differences existed in GLS,GWW and GWE.The term asphyxia group(15 cases)showed significantly lower GWW than the term control group(25 cases)[45.0(30.0,65.0)mmHg vs.71.0(35.5,85.5)mmHg](P<0.05).No differences existed in GLS,GWI,GCW and GWE.GWI was negatively correlated with serum NT-proBNP level(r=-0.327,P<0.05).ConclusionsGWI and GCW may indicate myocardial injury in preterm neonates with mild asphyxia.