Evans N J, Archer L N
Department of Paediatrics, John Radcliffe Maternity Hospital, Oxford.
Arch Dis Child. 1991 Jan;66(1 Spec No):6-11. doi: 10.1136/adc.66.1_spec_no.6.
The natural history of pulmonary artery pressure and extrapulmonary shunting in acute hyaline membrane disease was studied by serial Doppler echocardiography in 57 preterm infants, 38 with, and 19 without, hyaline membrane disease. Pulmonary artery pressure was assessed non-invasively by its inverse relationship with the ratio of pulmonary artery Doppler time to peak velocity: right ventricular ejection time. The mean ratio was significantly lower in the infants with hyaline membrane disease. The mean ratio for each infant with hyaline membrane disease varied widely and did not correlate with criteria of maturity or severity of disease. Individual ratios correlated with arterial pH. Between 60-80 hours after birth, 14 of 18 infants with hyaline membrane disease (78%) and one of 19 without (5%) had patent ductus arteriosus. Left to right and bidirectional shunting at ductal and atrial level were common; pure right to left shunting was uncommon. The mean ratio seen with bidirectional shunting was significantly lower than that seen with left to right shunting. Ratios and patterns of extra pulmonary shunting were similar when the fractional inspired oxygen (FIO2) was greater than 0.9 compared with when it was less than 0.9. Pulmonary artery pressure is high during the acute phase of hyaline membrane disease but varies widely among infants. A few infants have extrapulmonary right to left shunting, and these infants are difficult to detect clinically.
通过对57例早产儿进行连续多普勒超声心动图检查，研究了急性透明膜病时肺动脉压和肺外分流的自然病程，其中38例患有透明膜病，19例未患透明膜病。通过肺动脉多普勒时间与峰值速度之比（即右心室射血时间）的反比关系对肺动脉压进行无创评估。透明膜病患儿的平均比值显著较低。每个患有透明膜病的婴儿的平均比值差异很大，且与成熟度或疾病严重程度标准无关。个体比值与动脉pH值相关。出生后60 - 80小时之间，18例患有透明膜病的婴儿中有14例（78%）以及19例未患透明膜病的婴儿中有1例（5%）存在动脉导管未闭。导管水平和心房水平的左向右和双向分流很常见；单纯右向左分流不常见。双向分流时的平均比值显著低于左向右分流时的平均比值。当吸入氧分数（FIO2）大于0.9时与小于0.9时相比，肺外分流的比值和模式相似。透明膜病急性期肺动脉压较高，但婴儿之间差异很大。少数婴儿存在肺外右向左分流，且这些婴儿临床上难以检测到。
