早期新生儿脉冲组织多普勒超声心动图的研究

目的 探讨脉冲组织多普勒技术评价早期新生儿心功能并了解心动周期中各时间间期及其随心率的变化规律.方法 86例出生2天、3天、4天新生儿,采用TDI技术检测早期新生儿二、三尖瓣环运动,测量收缩期峰值速度(Sa),舒张早期峰值速度(Ea)与舒张晚期峰值速度(Aa)比值(Ea/Aa),E与Ea比值(E/Ea),以及TDI频谱各时间间期.分别以日龄和性别分组,比较组间以及左右室之间上述各指标差异性,并进行时间间期与心率的相关性分析.结果 Sa、Ea/Aa及E/Ea在不同H龄间差异均无显著性(P＞0.05).男性新生儿与女性二尖瓣环左室侧Ea/Aa(0.89±0.31 vs 1.09±0.29,P=0.005)及E/Ea(10.98±2.24 vs 9.38±2.62,P=0.008)、三尖瓣环与二尖瓣环Sa(5.74±0.10 vs 4.30±0.93,P=0.000)、Ea/Aa(0.85±0.25 vs 1.00±0.32,P=0.003)及E/Ea(7.22±2.42 vs 10.09±2.57,P=0.000)差异均有显著性.各时间间期在不同口龄组间差异无显著性;男性新生儿与女性左室总舒张时间(207.14±34.70 vs 230.00±48.16,P=0.013)差异具有显著性;除外舒张后期时间,所有时间间期指标左右室间差异均有显著性(P＜0.01).新生儿收缩时间与舒张时间之比约0.54/0.46.心率与舒张早期时间、舒张后期时间强负相关(r=-0.547,-0.687).与心房收缩时间无相关关系,而与等容收缩时间,射血时间均弱负柑关(r=-0.280,-0.374).结论 早期新生儿心功能日龄间无差异;女性新生儿的心室舒张功能优于男性,而收缩功能无性别差异.左室舒张时间男性新生儿短于女性;右室的收缩早于左室,并且右室的收缩时间比左室长.心率增快主要影响舒张后期时间和舒张早期时间,与心房收缩时间无相关关系.

Study of pulse tissue Doppler echocardiography in early neonate

Objective To evaluate the ventricular function and the cardiac interval in early neonates by tissue Doppler imaging (TDI). Methods Eighty-six early neonates were investigated by pulse tissue Doppler imaging. The peak velocities of Ea wave, Aa wave and Sa wave were measured in mitral and tricuspid annulus. Tansmitral and transtricuspid inflow (E, A) were also obtained through pulsed Doppler echocardiography. The ratio of Ea wave to Aa wave (Ea/Aa) and E/Ea was calculated, and the intervals of cardiac cycle were also measured. Results There was no significant difference in the values of Sa, Ea/Aa and E/Ea among the different age groups,whereas significant difference was observed between the boys and the girls (0.89±0.31 vs 1.09±0.29, P=0.005) at the mitral lateral wall, also between the right and the left ventricular (Sa: 5.74±0.10 vs 4.30±0.93, P=0.000; Ea/Aa: 0.85±0.25 vs 1.00±0.32, P=0.003; E/Ea: 7.22±2.42 vs 10.09±2.57, P=0.000). There was no significant difference of the intervals among the different age groups. The total relaxation interval in left ventricular was different between boys and girls (207.14±34.70 vs 230.00±48.16, P=0.013). All of the cardiac intervals were significantly different between the left and right ventriculars (P<0.01) except diastasis, and the time ratio between systole and diastole was 0.54/0.46. The early relaxation interval, diastasis demonstrated a stronger relation with heart rate, and arterial contraction time showed no correlation with heart rate. Conclusion The ventricular function is not significantly different among the ages. However, the left diastolic function is significant better in girls than in boys, but no significant difference of systolic function exists. The relaxation interval of left ventricular is shorter in boys than in girls. The right ventricular contract is earlier and the total time intervals are longer in newborns. When heart rate increases, the intervals decrease most in diastasis, but not correlate with artrial contraction time.