Nestaas Eirik, Skranes Janne Helen, Støylen Asbjørn, Brunvand Leif, Fugelseth Drude
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Paediatrics, Vestfold Hospital Trust, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Neonatal Intensive Care, Oslo University Hospital, Ullevål, Norway.
Early Hum Dev. 2014 May;90(5):247-52. doi: 10.1016/j.earlhumdev.2014.01.014. Epub 2014 Mar 4.
Therapeutic hypothermia has become standard treatment for moderate and severe neonatal hypoxic-ischemic encephalopathy (HIE) to reduce cerebral morbidity and mortality. The effect on the heart is incompletely explored.
To assess the myocardial function during and after whole-body therapeutic hypothermia for HIE.
Observational cohort study.
Forty-four infants with HIE cooled for 72hours were compared with 48 healthy term infants and 20 normothermic infants with HIE.
Tissue Doppler deformation indices of myocardial function (peak systolic strain, peak systolic strain-rate, early diastole strain-rate and strain-rate in atrial systole) during (days 1 and 3) and after (day 4) therapeutic hypothermia.
On days one and three all indices in both HIE groups were lower than the corresponding indices in the healthy infants. The two HIE groups had similar indices, except peak systolic strain-rate on days 1 and 3 and strain-rate in atrial systole on day 1. All strain-rate indices improved from day 3 to 4 (after rewarming) in the cooled group and achieved similar values to those in healthy infants on day 3. All indices were higher in the cooling-group after rewarming than in the normothermic infants with HIE on day 3, except early diastolic strain-rate.
Infants with HIE had similarly impaired myocardial function during days 1-3 whether normothermic or hypothermic. The myocardial function improved significantly at day 4 (after rewarming), approaching the day 3 levels in the healthy neonates.
治疗性低温已成为中重度新生儿缺氧缺血性脑病（HIE）的标准治疗方法，以降低脑损伤发病率和死亡率。其对心脏的影响尚未完全探究清楚。
评估全身治疗性低温治疗HIE期间及之后的心肌功能。
观察性队列研究。
将44例接受72小时低温治疗的HIE婴儿与48例健康足月儿及20例体温正常的HIE婴儿进行比较。
治疗性低温期间（第1天和第3天）及之后（第4天）心肌功能的组织多普勒变形指标（收缩期峰值应变、收缩期峰值应变率、舒张早期应变率和心房收缩期应变率）。
在第1天和第3天，两个HIE组的所有指标均低于健康婴儿的相应指标。两个HIE组的指标相似，但第1天和第3天的收缩期峰值应变率以及第1天的心房收缩期应变率除外。在低温治疗组中，所有应变率指标从第3天到第4天（复温后）均有所改善，并在第3天达到与健康婴儿相似的值。复温后，除舒张早期应变率外，低温治疗组的所有指标在第3天均高于体温正常的HIE婴儿。
HIE婴儿在第1 - 3天，无论体温正常还是处于低温状态，心肌功能均有类似损害。在第4天（复温后）心肌功能显著改善，接近健康新生儿第3天的水平。
