摘要
目的研究新生儿窒息多脏器损伤的机理，提供早期诊断方法。方法应用美国Ｕｌｔｒａｍａｒｋ－９型彩色超声诊断仪及丹麦ＡＢＬ－５００型血气分析仪等，对新生儿窒息全身性多脏器血流动力学变化进行有对照组的前瞻性研究。结果（１）窒息新生儿脑、肾上腺、肾、肝、脾、胃及肠道等各脏器血液灌流量均减少，尤以舒张期为甚；但各脏器减少的程度不一致。（２）肺动脉压力与阻力增高，严重者可致持续胎儿循环，是病情严重的标志。（３）心脏功能障碍是缺氧缺血性心肌损伤的结果，窒息性心功能障碍表现为舒张功能首先受累，而收缩功能障碍则右室重于左室。（４）低氧血症是新生儿窒息各脏器损伤的病理生理基础，且低氧血症的程度与各脏器血流速度减慢的程度呈高度正相关（ｒ＝０．９３～０．９８，Ｐ均＜０．０１），与左室射血分数降低的程度呈高度正相关（ｒ＝０．９１，Ｐ＜０．０１），与肺动脉压力增高的程度呈高度负相关（ｒ＝－０．９７，Ｐ＜０．０１）。ＱＴ离散度是评价新生儿缺氧缺血性心肌损伤特异而敏感的指标。结论血流动力学紊乱是新生儿窒息各脏器损伤的主要原因，肺动脉压升高是新生儿窒息的重要病理生理变化。超声检测各脏器血流动力学变化。
Objective To study the pathogenesis of multiple organs injury in asphyxiated neonates and to offer early diagnostic methods. Methods The authors prospectively observed the variation of hemodynamics of multiple organs in asphyxiated neonates and healthy controls by using an Ultramark 9 ultrasongraph. Results (1) The blood perfusion of the organs including brain, adrenal gland, kidney, liver, spleen and gastrointestinal tract was decreased; (2) pulmonary arterial pressure and pulmonary artery resistance were elevated and even persistent fetal circulation occurred in severe cases; (3) cardiac dysfunction, predominately right ventricular dysfunction was observed in neonates after asphyxia. Also, the diastolic dysfunction appeared earlier than the systolic dysfunction did; (4) the degree of hypoxemia positively correlated with the degree of deceleration of blood flow velocity of each organs ( r=0.93～0.98, P<0.01 ) and with the degree of decrease in left ventricular ejectional fraction ( r=0.91, P<0.01 ), and negatively correlated with the degree of pulmonary hypertension ( r= -0.97, P<0.01 ). Furthermore, it was demonstrated that QT dispersion was a sensitive and specific index to assess the hypoxic ischemic myocardial injury in neonates. Conclusion The hemodynamic disturbance was the main reason for multiple organ injury in neonates with asphyxia and pulmonary hypertension was an important pathophysiologic process in neonatal asphyxia.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
1998年第2期69-73,共5页
Chinese Journal of Pediatrics
