心排血量测定在新生儿缺氧缺血性脑病中的临床意义

目的观察新生儿缺氧缺血性脑病(HIE)患儿的心排血量(CO)变化,探讨其与临床表现及预后的关系。方法利用二维及多普勒超声对25例轻、中度和19例重度HIE患儿及14例正常新生儿进行CO测定,并分析其与临床表现及预后的关系。结果急性期与正常新生儿及轻、中度HIE组比较,重度HIE组心率(HR)增块(P<0.05),每搏排出量(SV)、CO及心脏指数(CI)降低(P<0.05);轻、中度HIE组HR较正常组增快(P<0.05),SV、CO及CI与正常组比较无差异(P>0.05)。恢复期上述指标无差异(P>0.05)。以CI低于正常组95%正常值范围的下限2.57为准,急性期轻、中度和重度HIE组分别有3和15例,二者比较差异显著(χ2=20.016,P<0.0001);CI降低的18例中死亡5例,CI正常的26例中死亡1例,二者比较差异显著(P=0.034)。结论重度HIE患儿CO明显下降,可考虑干预治疗。

Clinical Significance of Measurements of Cardiac Output in Newborns with Hypoxic-ischemic Encephalopathy

Objective To investigate changes of cardiac output （CO） in newborns with hypoxic-ischemic encephalopathy （HIE） and their relationship with clinical manifestation and prognosis. Method Stroke volume （SV）, CO, cardiac index （CI） and heart rate（HR） were measured by using tow-dimensional and Doppler echocardiography in 25 mild to moderate and 19 severe HIE neonates as well as 14 normal controls. The relationship between changes of cardiac output and clinical manifestation and prognosis was approached. Result In acute stage severe HIE groups had a higher HR （P〈0.05） and a decreased SV, CO and CI （P〈0.05） in comparison with mild to moderate HIE and normal groups. There were no differences in SV, CO and CI between mild to moderate HIE and normal groups （P〉0.05）, but a higher HR was found in mild to moderate HIE groups compared with normal controls （P〈0.05）. No significant difference was observed among three groups in HR, SV, CO and CI in convalescence （/＇〉0.05）. In severe HIE group the cases （15/19） whose CI was lower than 2.57, low limit of 95% normal range calculated from controls, were much more than those （3/25） in mild to moderate HIE groups （x^2=20.016, P〈0.0001）. 5 cases in 18 neonates with lower CI died and only 1 did in 26 newborns with normal CI, there was a significant difference between two groups （P=-0.034）. Conclusion Severe HIE neonates had a diminished cardiac output, intervention therapy should be considered to take out on them.