对缺血缺氧性脑病新生儿心功能的超声研究

目的运用超声应变率显像(SRI)技术测定缺氧缺血性脑病(HIE)患儿左心室侧壁的位移,以此评价患儿心功能受损情况,及早为临床提供治疗信息。方法选取2009年1月至2011年5月40例HIE新生患儿,按临床轻、中度分级各20例,胎龄37.8～40.9周,平均胎龄39.5周;体质量2.83～3.89kg,平均体质量3.34kg。并选取20例正常出生足月儿做对照组,胎龄38.2～41.1周,平均胎龄40.1周;体质量2.92～3.68kg,平均体质量3.26 kg。分别采集大脑中动脉(MCA)的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI);标准四腔心切面,应用应变率技术测量左心室侧壁基底段及中间段的收缩期应变率(SSR)、舒张早期应变率(ESR)、舒张晚期应变率(ASR);二、三尖瓣口血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及左心室射血分数(LVEF),对所获指标进行定量分析。结果轻度和中度HIE组与正常对照组比较,其MCA血流的Vs和Vd均减低(P<0.01),RI均增加(P<0.05);中度HIE组LVEF较正常新生儿LVEF低,轻度者无明显变化,但两组患儿的左心室壁基底段、中间段位点的收缩期位移低于对照组(P<0.05),差异具有统计学意义。结论超声应变率技术可无创、敏感、准确地评价HIE患儿的心功能变化,为临床提供治疗信息。

Study on cardiac function of children with hypoxic ischemic encephalopathy by ultrasound

Objective To evaluate children with heart damage and provide clinical information for early treatment through detecting the displacement of left ventricular wall in hypoxic ischemic encephalopathy(HIE) by strain rate imaging(SRI).Methods A total of 40 cases of HIE from January 2009 to May 2011 were enrolled and divided into mild and moderate grade groups.There were 20 cases in each group,gestational age 37.8-40.9 weeks,mean gestational age 39.5 weeks;body mass of 2.83-3.89 kg,average body mass 3.34 kg.The 20 normal full-term born children were selected as control group,gestational age 38.2-41.1 weeks,mean gestational age 40.1 weeks;body mass of 2.92-3.68 kg,average body mass of 3.26 kg.The peak systolic velocity(Vs),end diastolic velocity(Vd) and resistance index(RI) of middle cerebral artery(MCA) were collected;The standard four-chamber view,left ventricular wall of basement section and the middle section of systolic strain rate(SSR),early diastolic strain rate(ESR),late diastolic strain rate(ASR);mitral,tricuspid early diastolic peak flow velocity(E),late diastolic peak flow velocity(A) and left ventricular ejection fraction(LVEF) were quantitative analyzed.Results Compared with normal group,the Vs and Vd of MCA were decreased in mild and moderate HIE group(P < 0.01),and RI were increased(P < 0.05);The LVEF of moderate HIE group was lower than that of normal group,and mild group was no significant changed,but left ventricular basal segments and middle point of systolic displacement of 2 groups were lower than that of the control group(P < 0.05),and which had statistical significance.Conclusion It is demonstrated that ultrasonic strain rate technique can be used as a non-invasive,sensitive and accurate method for evaluation of cardiac function in children with HIE,and it could provide clinical information for early treatment.