Herdy G V, Lopes V G, Aragão M L, Pinto C A, Tavares Júnior P A, Azeredo F B, Nascimento P M
Hospital Universitário Antônio Pedro, Niterói, RJ.
Arq Bras Cardiol. 1998 Aug;71(2):121-6. doi: 10.1590/s0066-782x1998000800005.
To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hypoxia.
Ninety babies with an Apgar score < or = 6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination.
From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH < 7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%).
In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.
评估新生儿窒息心脏并发症的严重程度与缺氧时间及程度的关系。
七年间，在我们机构的重症监护病房对90例阿氏评分≤6分的婴儿进行了检查。采集动脉血用于检测pH值、葡萄糖、乳酸脱氢酶（LDH）及肌酸激酶（CK）的MB同工酶，同时进行系列心电图（ECG）、超声心动图及胸部X线检查。对死亡病例进行大体及显微镜检查。
90例中，73例为早产儿：30例（41%）适于胎龄（AGA），43例（59%）小于胎龄（SGA）。21例（23%）动脉pH值＜7.2。最常见的临床情况为：肺炎28例（31%）、贫血24例（26%）及黄疸12例（13%）。主要心脏检查结果为：收缩期杂音46例（50%）、心脏肥大体征18例（20%）及心力衰竭8例（9%）。心电图主要表现为ST段和T波异常。超声心动图显示动脉导管未闭（PDA）20例（22%）、三尖瓣反流6例（7%）、肺动脉高压6例（7%）、运动障碍及心室扩张4例（5%）。23例进行了尸检，14例获得了大体及显微镜检查结果；最常见的表现为：心肌细胞坏死8例（54%）、充血、空泡形成及横纹消失4例（29%）。
大多数病例病情呈良性，即使是那些出现严重酸血症的病例。许多异常的心电图和超声心动图在几周后恢复正常。在死亡病例中，组织学损伤的严重程度在窒息时间较长的婴儿中更为明显。
