超声心动图指标预测新生儿动脉导管自然关闭的价值

目的:探讨早期超声心动图指标能否预测新生儿动脉导管自然关闭。方法:足月新生儿在出生后3天内进行初次超声心动图检查,观察动脉导管是否已经闭合,若动脉导管未闭且没有其它畸形,则进行随访观察,随访超过12月未闭合者则认为是无法自然闭合的动脉导管未闭患者。1995年1月~2005年3月本院共有45例随访12月动脉导管尚未闭合的患者(PDA组),另随机选取50例3天内动脉导管已经闭合的小儿作为对照组(CONTROL组),比较两组间的超声心动图指标。结果:PDA组的左房?蛐主动脉比值(LA/AO)、左室?蛐主动脉比值(LVIDd/AO)、动脉导管彩色血流最细处宽度及动脉导管肺动脉侧左向右分流速度明显高于对照组(P值分别为:P<0.001,P<0.01,P<0.001,P<0.001)。LA/AO<1.30,LVIDd/AO<1.82及动脉导管彩色血流最细处宽度<0.29cm时,预示动脉导管多可以自然关闭。LA/AO>1.39,LVIDd/AO>1.97及动脉导管彩色血流最细处宽度>0.33cm时,预示动脉导管多无法自然关闭,选择合适时机进一步治疗是必要的。结论:足月产新生儿的早期超声心动图指标对预测动脉导管能否自然关闭是非常有价值的。

Value of echocardiographic indices in predicting the spontaneous closure of ductus arteriosus among neonates

Objective: To investigate whether the spontaneous closure of ductus arteriosus could be predicted by early echocardiographic indices. Methods: The term neonates were examined with echocardiography 1 to 3 days after birth. The presence or absence of a hemodynamically significant ductus shunt was judged from echocardiographic indices. If the ductus arteriosus was not closed, follow-up research were made. From January 1995 to March 2005, there were 45 subjects in our hospital whose ductus did not close spontaneously within a one-year follow-up(PDA group), and 50 subjects whose ductus closed spontaneously within 3 days were collected randomly served as controls(CONTROL group). The echocardiographic indices were compared between the two groups. Results: The LA/AO, LVIDd/AO, the smallest width of ductal color Doppler flow jet and the velocity at the pulmonary end of the duct in PDA group were found to be significantly higher than those in CONTROL group(P<0.001, P<0.01, P<0.001, P<0.001 respectively). LA/AO<1.30, LVIDd/AO<1.82, and the smallest width of ductal color Doppler flow jet<0.29cm were good indicators for prediction that the ductus arteriosus could be closed spontaneously. LA/AO>1.39, LVIDd/AO>1.97, and the smallest width of ductal color Doppler flow jet>0.33cm indicated that the ductus arteriosus could not be closed spontaneously, and further treatment was necessary. Conclusion: The early echocardiographic indices of term neonates was very valuable to predict the spontaneous closure of ductus arteriosus.