窒息新生儿肾血流动力学与肾功能指标的相关性

目的探讨不同窒息程度新生儿肾血流动力学与肾功能指标变化的相关性。方法对71例窒息新生儿和20例健康新生儿在出生后1～3 d和5～7 d时,测定尿酶和血清尿素、肌酐的水平;在生后第1天、第3天和第7天采用彩色超声测定肾动脉血流参数变化。结果生后1～3 d时,窒息组与对照组比较,尿酶和血清尿素、肌酐水平显著升高（P〈0.05）,以重度窒息组升高为显著。生后第1天时,窒息组与对照组比较,肾动脉血流速度降低（P〈0.01）,血管阻力增大（P〈0.05）。生后第1天肾血流动力参数与生后1～3 d尿酶、血清尿素、肌酐呈明显的相关性,肾动脉血流速度与尿酶和血清尿素、肌酐水平呈负相关（P〈0.01）,血管阻力与尿酶和血清尿素、肌酐水平呈正相关（P〈0.05）。结论尿酶、血清尿素、肌酐和肾血流动力参数的测定对窒息新生儿肾功能损伤的早期诊断具有重要作用,缺血缺氧是导致新生儿肾血流动力学改变及肾功能异常的重要因素。

Changes and related research of urease, serum urea nitrogen, creat and renal blood flow in newborns with asphyxia

Objective To observe correlation of renal hemodynamic and renal function in newborns with different asphyxia. Methods 71 cases of newborns with asphyxia and 20 healthy newborns in one to three and five to seven days after birth were tested for urine enzymes and serum urea, creatinine level. Color Doppler ultrasound technology was adopted to monitor the changes of renal hemodynamic index on the first day, the second day and the seventh day after birth. Results In one to three days after birth, the activity of urine enzymes and serum urea, creatinine level in neonatal group of suffocation were higher than those in normal neona- tal group （P 〈0.05）, urine enzymes activity and serum urea, creatinine level in severe asphyxia group were increased significantly. On the first day after birth, the rate of renal aorta blood flow in neonatal group of suffocation was lower than that in normal neonatal group （P 〈0.01）; and ream aorta resistance was higher in asphyxia group （P 〈0.05）. The change in mild asphyxia was obvious, but the change in severe asphyxia was even more obvious. Renal hemodynamic index on the first day after birth and urine enzymes and serum urea, creatinine in one to three days after birth had significant correlation. The rate of renal aorta blood flow and urine enzymes and serum urea, creatinine were negatively correlated （P 〈0.01）. Aorta resistance and urine enzymes and serum urea, creatinine were positively correlated （P 〈0.05）. Conclusion The test of urine enzymes and serum urea, creatinine and renal hemodynamic index play an important role for the early diagnosis of impaired renal function in newborns with asphyxia. The lack of blood and oxygen is an important factor for the changes of renal hemodynamic and abnormal renal function.