Gill A B, Weindling A M
Department of Child Health, University of Liverpool, Liverpool Maternity Hospital.
Arch Dis Child. 1993 Mar;68(3 Spec No):303-7. doi: 10.1136/adc.68.3_spec_no.303.
Pulmonary artery pressure may be estimated non-invasively in the premature newborn infant because of its negative correlation with the time to peak velocity:right ventricular ejection time (TPV:RVET) ratio calculated from the pulmonary artery Doppler waveform. We studied 54 very low birthweight infants on days 1, 2, 3, 7, 14, 21, and 28 after birth. Thirty four infants developed chronic lung disease (CLD). Twenty did not and acted as controls. After correcting the TPV:RVET ratio for heart rate (TPV:RVET(c)), during the first 14 days the TPV:RVET(c) ratio rose progressively in both groups suggesting a fall in pulmonary artery pressure. This occurred at a significantly slower rate in the CLD group. From days 14 to 28 there was a significant fall in the ratio in the CLD group only, suggesting an increase in pulmonary artery pressure. Using CLD as the end point, a TPV:RVET(c) ratio < 0.54 on day 7 had a predictive value of 78% (sensitivity 73%, specificity 65%). This rose to a predictive value of 97% (sensitivity 88%, specificity 95%) on day 28. The non-invasive assessment of pulmonary artery pressure may be useful in the early clinical management of the very low birthweight infant at risk of developing CLD.
由于肺动脉压力与峰值速度时间（从肺动脉多普勒波形计算出的右心室射血时间[TPV:RVET]比值）呈负相关，因此可对早产新生儿进行无创肺动脉压力估计。我们对54例极低出生体重儿在出生后第1、2、3、7、14、21和28天进行了研究。34例婴儿发生了慢性肺病（CLD）。20例未发生慢性肺病，作为对照组。在对心率校正TPV:RVET比值（TPV:RVET(c)）后，在最初14天内，两组的TPV:RVET(c)比值均逐渐上升，提示肺动脉压力下降。CLD组的上升速度明显较慢。从第14天到第28天，仅CLD组的该比值出现显著下降，提示肺动脉压力升高。以CLD为终点，第7天TPV:RVET(c)比值<0.54的预测价值为78%（敏感性73%，特异性65%）。到第28天时，预测价值升至97%（敏感性88%，特异性95%）。对有发生CLD风险的极低出生体重儿进行肺动脉压力的无创评估可能有助于早期临床管理。
