出生后即刻对动脉导管血流进行无创测量。

Non-invasive measurements of ductus arteriosus flow directly after birth.

作者信息

van Vonderen Jeroen J, te Pas Arjan B, Kolster-Bijdevaate Clara, van Lith Jan M, Blom Nico A, Hooper Stuart B, Roest Arno A W

机构信息

Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):F408-12. doi: 10.1136/archdischild-2014-306033. Epub 2014 Jun 25.

DOI:10.1136/archdischild-2014-306033

PMID:24966129

Abstract

OBJECTIVE

To assess ductus arteriosus (DA) blood flow directly after birth in healthy term infants after elective caesarean section.

DESIGN

In healthy term newborns, echocardiography was performed at 2, 5 and 10 min after birth to monitor cardiac output and DA blood flow. Heart rate (HR) was assessed using ECG.

SETTING

The delivery rooms of the Leiden University Medical Center.

PATIENTS

24 healthy term infants born after a caesarean section were included in this study.

RESULTS

Mean (SD) HR did not change (158 (18) beats per minute (bpm), 5 min (159 (23) bpm) and 10 min (156 (19) bpm). DA diameter decreased from 5.2 (1.3) mm at 2 min to 4.6 (1.3) mm at 5 min (p=0.01) to (3.9 (1.2) mm) (p=0.01) at 10 min. Right-to-left DA shunting was unaltered (median (IQR) 95 (64-154) mL/kg/min to 90 (56-168) mL/kg/min and 80 (64-120) mL/kg/min, respectively (ns)), whereas left-to-right shunting significantly increased between 2 and 5 min (41 (31-70) mL/kg/min vs 67 (37-102) mL/kg/min (p=0.01)) and increased significantly between 2 and 10 min (93 (67-125)) mL/kg/min (p<0.001). Right-to-left/left-to-right shunting ratio decreased significantly from 2.1 (1.4-3.1) at 2 min to 1.4 (1.0-1.8) at 5 min (p<0.0001) and to 0.9 (0.6-1.1) at 10 min (p<0.0001).

CONCLUSIONS

DA shunting changes swiftly from predominantly right-to-left shunting to predominantly left-to-right shunting at 10 min after birth, reflecting differential changes in pulmonary and systemic vascular resistance.

摘要

目的

评估择期剖宫产术后足月健康新生儿出生后即刻的动脉导管（DA）血流情况。

设计

对足月健康新生儿在出生后2分钟、5分钟和10分钟进行超声心动图检查，以监测心输出量和DA血流。使用心电图评估心率（HR）。

地点

莱顿大学医学中心产房。

患者

本研究纳入24例剖宫产术后足月健康婴儿。

结果

平均（标准差）心率无变化（出生后5分钟为158（18）次/分钟（bpm），出生后10分钟为156（19）bpm）。DA直径从出生后2分钟时的5.2（1.3）mm降至出生后5分钟时的4.6（1.3）mm（p = 0.01），至出生后10分钟时降至3.9（1.2）mm（p = 0.01）。右向左DA分流未改变（中位数（四分位间距）分别为95（64 - 154）mL/kg/min、90（56 - 168）mL/kg/min和80（64 - 120）mL/kg/min（无显著差异）），而左向右分流在出生后2至5分钟显著增加（41（31 - 70）mL/kg/min对67（37 - 102）mL/kg/min（p = 0.01）），且在出生后2至10分钟显著增加（93（67 - 125）mL/kg/min（p < 0.001））。右向左/左向右分流比从出生后2分钟时的2.1（1.4 - 3.1）显著降至出生后5分钟时的1.4（1.0 - 1.8）（p < 0.0001），至出生后10分钟时降至0.9（0.6 - 1.1）（p < 0.0001）。