多普勒超声监测新生儿窒息患儿肾血流动力学变化

目的 探讨多普勒超声在新生儿窒息患儿肾功能损害的早期诊断、病情监测和疗效评估等临床应用中的价值。方法 选取60例出生时间在24 h内的新生儿，根据新生儿出生后1 min Apgar评分将其分为重度窒息组（Apgar评分0~3分）、轻度窒息组（Apgar评分4~7分）和正常对照组（Apgar评分8~10分）。在新生儿出生后24 h内、第3、7、10天，运用多普勒超声技术检测各组新生儿双侧肾动脉的收缩期峰值血流速度（PSV）、舒张期末血流速度（EDV）及阻力指数（RI）。同时采样血液标本，测定血清胱抑素C（sCysC）水平。结果 与正常对照组比较，出生后24 h内轻度及重度窒息组肾动脉PSV、EDV均不同程度降低（P均<0.05），RI不同程度升高（P均<0.05）。轻度窒息组PSV在出生后第3天已基本恢复正常，EDV、RI在出生后第10天已基本恢复正常，与正常对照组比较差异无统计学意义（P>0.05）；重度窒息组出生后第10天PSV、EDV、RI与正常对照组仍有显著差异（P均<0.05）。3组新生儿随日龄增加sCysC均呈下降趋势。轻度窒息组新生儿出生后24 h内、第3天sCysC水平较正常对照组明显升高（P均<0.05），第7天、第10天与正常对照组比较差异无统计学意义（P均>0.05）；各日龄重度窒息组患儿sCysC水平均较正常对照组明显升高（P均<0.05）。各组新生儿PSV、EDV与sCysC呈负相关；RI与sCysC呈正相关。结论 多普勒超声检测肾动脉血流动力学参数能早期准确地反映窒息新生儿肾功能状态。

Doppler ultrasound in monitoting hemodynamic changes of renal artery in neonatal asphyxia

Objective To investigate the value of Doppler ultrasound in the early diagnosis, monitoring and assessing of renal damage in neonatal asphyxia. Methods A total of 60 cases of neonates within 24 h were divided into severe asphyxia group (Apgar score 0-3), mild asphyxia group (Apgar score 4-7) and healthy control group (Apgar score 8-10) according to Apgar score at 1 min after born. Then the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) of renal artery were obtained by Doppler ultrasound within 24 h, on day 3, day 7, and day 10. The level of serum cystain C (sCysC) was also recorded accordingly. Results Within 24 h, compared with healthy control group, the PSV and EDV in severe asphyxia group and mild asphyxia group decreased (all P<0.05), while RI increased (all P<0.05). The PSV in mild asphyxia group returned to normal in 3 days, EDV and RI returned to normal in 10 days, there were no statistically significant difference compared with healthy control group (all P>0.05). The PSV, EDV and RI in severe asphyxia group were still significantly differences compared with healthy control group on day 10 (all P<0.05). Within 24 h and on day 3, sCysC in the mild asphyxia group increased obviously compared with healthy control group (both P<0.05). On day 7 and day 10, the differences of sCysC was not statistically significant between mild asphyxia group and healthy control group (both P>0.05). Compared with healthy control group, the sCysC in severe asphyxia group increased significantly (all P<0.05) on every time point. PSV and EDV were negatively correlated with sCysC, RI was positively correlated with sCysC. Conclusion Changes in renal function can be reflected soon by index of renal blood flow PSV, EDV and RI.