超声心动图比较经阴道分娩与剖宫产新生儿肺动脉压力

目的采用超声心动图比较经阴道分娩与剖宫产新生儿出生后肺动脉压力、动脉导管内径及闭合率的变化,探讨分娩方式对新生儿出生后循环转化过程的影响。资料与方法前瞻性纳入陕西省人民医院产科2019年4—11月出生的健康足月新生儿152例,按分娩方式分为经阴道分娩组92例和剖宫产组60例,分别于出生后2 h内、6 h、12 h、24 h、48 h、72 h行超声心动图检查,采用动脉导管压差法估测肺动脉收缩压(PASP)、舒张压(PADP)、平均压(PAMP),观察动脉导管内径及闭合时间,比较两组新生儿各时间段肺动脉压力及动脉导管内径、闭合率的变化。结果剖宫产组2 h内的PASP、PAMP高于经阴道分娩组(80.10±8.36)mmHg比(74.29±5.44)mmHg、(52.60±5.73)mmHg比(49.57±4.67)mmHg],差异有统计学意义(t=?3.371、?2.553,P均<0.05)。两组新生儿2 h内的动脉导管内径、闭合率、PADP以及6 h、12 h、24 h、48 h、72 h的PASP、PADP、PAMP、动脉导管内径及闭合率差异均无统计学意义(P>0.05)。结论剖宫产对新生儿动脉导管内径及闭合率无明显影响,但可以影响新生儿出生后肺动脉压力的下降过程,有发生肺动脉高压的风险。孕妇及产科医师在选择分娩方式时,要权衡利弊,慎重选择。

Comparison of Pulmonary Artery Pressure of Newborns Between Vaginal Delivery and Cesarean Section

Purpose To compare the changes of pulmonary artery pressure,ductus arteriosus diameter and closure rate between vaginal delivery and cesarean section by echocardiography,and to explore the influence of delivery methods on the circulatory transformation process of newborns after birth.Materials and Methods 152 cases of healthy full-term newborns born in the obstetrics department of Shaanxi Provincial People's Hospital from April to November 2019 were concluded.They were divided into vaginal delivery group(92 cases)and cesarean section group(60 cases)according to the delivery methods.Echocardiography was performed within 2 hours,6 hours,12 hours,24 hours,48 hours and 72 hours after birth respectively.The pulmonary artery systolic pressure(PASP),pulmonary artery diastolic pressure(PADP)and mean pulmonary artery pressure(PAMP)was estimated by the patentductus arteriosus pressure gradient method,and the ductus arteriosus diameter and closure rate were recorded.The changes of pulmonary artery pressure,ductus arteriosus diameter and closure rate were compared between the two groups.Results The PASP and PAMP within 2 hours in cesarean section group were higher than those in vaginal delivery group,and the difference was statistically significant(80.10±8.36)mmHg vs.(74.29±5.44)mmHg,(52.60±5.73)mmHg vs.(49.57±4.67)mmHg;t=?3.371 and?2.553,all P<0.05].There was no significant difference in the ductus arteriosus diameter,closure rate,PADP within 2 hours,and the PASP,PADP,PAMP,ductus arteriosus diameter and closure rate within 6 hours,12 hours,24 hours,48 hours and 72 hours between the two groups(P>0.05).Conclusion Cesarean section has no significant effect on the ductus arteriosus diameter and closure rate of the neonatal arterial duct,but it can affect the decrease of pulmonary artery pressure after birth,and there is a risk of pulmonary hypertension in newborns with cesarean section.Pregnant women and obstetricians should weigh the pros and cons when choosing the ways of delivery.