中国实用儿科杂志

中国实用儿科杂志 ›› 2010, Vol. 25 ›› Issue (01): 40-.

• 论著 • 上一篇    下一篇

新生儿缺氧性肺动脉高压对左室舒张功能的影响及其与血浆脑利钠肽相关性研究

胡亦新1，崔　华1，封志纯2   

  1. 1.解放军总医院南楼心血管二科，北京　100853；2.北京军区总医院附属八一儿童医院, 北京　100700
  • 收稿日期:2009-07-30 修回日期:2009-11-15 出版日期:2010-01-06 发布日期:2010-04-01

Effect of hypoxic pulmonary artery hypertension on diastolic function of left ventricular and its correlation with the plasma natriuretic peptide in neonates.

  1. *Second Department of Cardiology， General Hospital of People' s Liberation Army， Beijing 100853，China
  • Received:2009-07-30 Revised:2009-11-15 Online:2010-01-06 Published:2010-04-01

摘要：

评估缺氧新生儿肺动脉高压（PAH）的发生及其对左室形态及功能的影响，探讨缺氧性PAH新生儿血浆脑利钠肽（BNP）水平与左室舒张功能的关系。方法　选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室（NICU）收治的缺氧新生儿52例，根据彩色多普勒超声检查是否存在PAH分为PAH组（34例）与对照组（18例），比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果　（1） 与对照组相比，PAH组左室舒张末内径（LVDd）、右室内径（RV）、肺动脉内径（PA）明显增大（P < 0.05）；三尖瓣反流峰值（VTR）流速增快及肺动脉收缩压（PASP）升高（P < 0.05），室间隔增厚不明显（P > 0.05）。（2）PAH组二尖瓣口血流多普勒频谱A峰流速（AV）、舒张早期充盈时间速度积分（AVTI）及A峰流速与E峰流速比值（AV/EV）、左房充盈分数（AVTI /EVTI）均较对照组显著增加（P < 0.01）；PAH组的左室等容舒张时间（LIVRT） 延长，但与对照组相比差异无统计学意义（P > 0.05），EV、舒张末期充盈时间速度积分（EVTI）及E峰减速时间（DT）较对照组亦无明显改变（P > 0.05）。（3） PAH组血浆BNP水平较对照组显著升高（P < 0.05）。（4）相关分析表明，PASP与AV/EV比值呈正相关（r = 0.4126， P < 0.01）；PAH组AV/EV比值与血浆BNP水平呈正相关 （r =0.4326，P < 0.01）。 结论　缺氧新生儿PAH已引起左室心肌重塑表现及左室舒张功能减低， 监测血浆BNP水平对新生儿缺氧性PAH伴左心功能受损的早期诊断具有十分重要的临床意义。

关键词: 缺氧, 肺动脉高压, 左室功能, 脑利钠, 新生儿

Abstract:

To evaluate the effect of pulmonary artery hypertension（PAH） secondary to hypoxia in neonate on the left ventricular

diastolic function ， and its correlation with plasma natriuretic peptide（BNP） .  Methods　From Nov 2003 to Nov 2008，52 new born infants

with hypoxia in PLA General Hospital and Bayi Children's Hospital of Beijing Military Area Command General Hospital were divided  into  PAH

group（34 cases） and control group（18 cases）. To compare the index of Doppler echocardiography between the two groups and their

correlation with the diastolic function of left ventricular and the plasma natriuretic peptide. Results　（1）Doppler echocardiography showed

that the diameter of end diastolic left ventricular，the diameter of right ventricular（RV）， and the pulmonary artery（PA）diameter

increased significantly in PAH group compared with those in the control group （P < 0.05）. The PAH group also had higher velocity of

tricuspid valve regurgitation（VTR） and higher pulmonary artery systolic pressure（PASP） than that in the control group （P < 0.05）. （2）

The PAH group also had higher mitral peak A velocity ， higher mitral AV velocity time inter （AVTI）， and higher ratio of mitral AV to

mitral peak E velocity（EV）. The ratio of AVTI/EVTI was significantly increased in PAH group compared with that in the control group. There

were no significant change found about LIVRT， EV， EVTI and DT （P < 0.05）. （3）Compared with the control group， the level of plasma BNP

in PAH group was stepped up in the PAH group. （4）In the two groups， there was a positive correlation not only between the PASP and the

ratio of mitral AV/EV （r = 0.4126，P < 0.01） but also between the value of mitral hemodynamics index and the level of plasma BNP （r =

0.4326，P < 0.01）.  Conclusion　The PAH secondary to hypoxia in the newborn infants has led to the diastolic dysfunction and remodeling of

left ventricle， and it is important to monitor the plasma BNP in early diagonisis of left ventricular dysfunction in newborn infants with

PAH secondary to hypoxia.

Key words: hypoxia；pulmonary artery hypertension（PAH）；left ventricular function；brain natriuretic peptide（BNP）；neonate