透明膜病中动脉导管血流动力学的系列评估

Serial assessment of ductus arteriosus hemodynamics in hyaline membrane disease.

作者信息

Phillipos E Z, Robertson M A, Byrne P J

机构信息

Department of Pediatrics, Children's Health Centre, University of Alberta Edmonton, Canada.

出版信息

Pediatrics. 1996 Dec;98(6 Pt 1):1149-53.

PMID:8951268

Abstract

OBJECTIVES

To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease.

METHODS

Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV).

RESULTS

QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 +/- 133 ml/kg per minute) was significantly greater than the mean QRV (237 +/- 84 ml/kg per minute). There was a linear relationship between QLV-QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV-QRV (112 +/- 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV-QRV = 50 +/- 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 +/- 0.36 and 1.67 +/- 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 +/- 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 +/- 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia and retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants.

CONCLUSION

PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.

摘要

目的

评估多普勒超声心动图（DE）在量化动脉导管未闭（PDA）分流体积方面的有效性，并将PDA分流体积与透明膜病婴儿的临床结局相关联。

方法

对30例患有透明膜病的早产通气婴儿在出生后24小时内进行了98次DE检查，然后每隔48小时进行一次检查，最多进行三次检查，直至通气结束，拔管后进行最后一次检查。使用横截面积和流速积分计算右心室和左心室输出量（分别为QRV和QLV）以及PDA血流量。还测量了左心房与主动脉根部直径。临床结局与分流分数（QLV/QRV）相关联。

结果

QLV/QRV与左心房与主动脉根部直径比呈线性关系（n = 92；r = 0.79）。在无PDA的情况下（n = 33项研究），QRV与QLV呈线性关系（r = 0.88）。在存在PDA的情况下（n = 64项研究），平均QLV（334±133 ml/kg每分钟）显著大于平均QRV（237±84 ml/kg每分钟）。QLV-QRV（PDA分流体积）与PDA血流量之间存在线性关系（n = 60；r = 0.84）。在PDA仅存在左向右分流的研究中（n = 48），平均QLV-QRV（112±83 ml/kg每分钟）显著高于双向分流的研究（n = 16；平均QLV-QRV = 50±27 ml/kg每分钟）。两名患有严重脑室内出血（IVH 3级）的婴儿和两名患有脑室周围白质软化（PVL）的婴儿的QLV/QRV（分别为2.09±0.36和1.67±0.02）显著高于无IVH的婴儿（n = 6；QLV/QRV = 1.31±0.18）或患有IVH 1级和2级的婴儿（n = 8；QLV/QRV = 1.48±0.27）。患有或未患有支气管肺发育不良和早产儿视网膜病变的婴儿的QLV/QRV没有差异。30例婴儿中均未发生坏死性小肠结肠炎。