Su B H, Watanabe T, Shimizu M, Yanagisawa M
Department of Neonatology, Tokyo Metropolitan Tsukiji Maternity Hospital, Japan.
Arch Dis Child Fetal Neonatal Ed. 1997 Jul;77(1):F23-7. doi: 10.1136/fn.77.1.f23.
To evaluate the pulmonary artery pressure (PAP) change in very low birth-weight (VLBW) infants at risk of chronic lung disease (CLD).
The time to peak velocity:right ventricular ejection time (TPV:RVET) ratio calculated from the pulmonary artery Doppler waveform, which is inversely related to PAP, was used. The TPV:RVET ratio was corrected for different heart rate (TPV:RVET(c)). Seventy three VLBW infants studied on days 1, 2, 3, 7, 14, 21 and 28 were enrolled for the analysis.
Twenty two infants developed CLD with a characteristic chest radiograph at day 28. Fifty one did not, of whom 17 were oxygen dependent on account of apnoea rather than respiratory disease, and 34 were non-oxygen dependent. The TPV:RVET(c) ratio rose progressively in all three groups over the first three days of life, suggesting a fall in PAP. In the oxygen and non-oxygen dependent groups, the mean (SD) ratio rose to 0.53 (0.09) and 0.57 (0.09), respectively, on day 7, then remained relatively constant thereafter. The CLD group rose more slowly after day 3 and had a significantly lower mean ratio from day 7 onwards compared with the other two groups (day 7: P < 0.001, days 14-28: P < 0.0001), and fell significantly from 0.47 (0.11) on day 7 to 0.41 (0.07) on day 28 (P = 0.01), suggesting a progressive rise in PAP. The mean (SD) ratios at day 28 of all infants were: CLD group 0.41 (0.07); oxygen dependent group 0.66 (0.15); and the non-oxygen group 0.67 (0.11). The CLD group had a significantly lower ratio than the oxygen dependent group and the non-oxygen group (P < 0.0001). Using the TPV:RVET(c) ratio of < 0.46, infants at risk of developing CLD could be predicted on day 7 (predictive value 82.8%, sensitivity 54.5%, specificity 94.1%).
The non-invasive assessment of PAP using the TPV:RVET(c) ratio may be useful in the longitudinal monitoring of PAP change in VLBW infants, and for prediction of chronic lung disease.
评估有慢性肺部疾病（CLD）风险的极低出生体重（VLBW）婴儿的肺动脉压（PAP）变化。
使用从肺动脉多普勒波形计算出的峰值速度与右心室射血时间（TPV:RVET）之比，该比值与PAP呈负相关。TPV:RVET比值针对不同心率进行了校正（TPV:RVET(c)）。纳入73例VLBW婴儿，分别在出生第1、2、3、7、14、21和28天进行研究并分析。
22例婴儿在第28天胸部X线片出现CLD特征。51例未出现，其中17例因呼吸暂停而非呼吸系统疾病依赖吸氧，34例不依赖吸氧。在出生后的前三天，三组婴儿的TPV:RVET(c)比值均逐渐升高，提示PAP下降。在依赖吸氧组和不依赖吸氧组中，平均（标准差）比值在第7天分别升至0.53（0.09）和0.57（0.09），此后保持相对稳定。CLD组在第3天后上升较慢，从第7天起平均比值显著低于其他两组（第7天：P<0.001，第14 - 28天：P<0.0001），且从第7天的0.47（0.11）显著降至第28天的0.41（0.07）（P = 0.01），提示PAP逐渐升高。所有婴儿在第28天的平均（标准差）比值分别为：CLD组0.41（0.07）；依赖吸氧组0.66（0.15）；不依赖吸氧组0.67（0.11）。CLD组的比值显著低于依赖吸氧组和不依赖吸氧组（P<0.0001）。使用TPV:RVET(c)比值<0.46，可在第7天预测有发生CLD风险的婴儿（预测值82.8%，敏感性54.5%，特异性94.1%）。
使用TPV:RVET(c)比值对PAP进行无创评估，可能有助于对VLBW婴儿PAP变化进行纵向监测，并用于预测慢性肺部疾病。
