心力储备对预测窒息新生儿心肌损害的价值探讨

摘要

Objective To discuss the value of cardiac contractility reserve(CCR)on prediction of myocardial damage in asphyxia newborns.Methods Altogether 155 newborns hospitalized in Chengdu Women and Children's Center Hospital from November 2014 to November 2016 were selected,among which 105 cases were asphyxia newborns combined with myocardial damage,including 55 severe asphyxia neonates assigned into severe asphyxia group and 50 mild asphyxia neonates assigned inot mild asphyxia group,and another 50 healthy newborns were as control group.CCR data was calculated through amplitude and time limit of relevant indexes of cardiac sound measurement.Lateral femoral peripheral venous blood was taken to measure serum creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),aspartate aminotransferase(AST)and cardiac troponin 1(cTn1). Relationship between CCR and myocardial enzymogram was analyzed.Results CK,CK-MB,cTn1 levels in mild and severe asphyxia groups were significantly higher than those in healthy controls,and the indexes in newborns with severe asphyxia were significantly higher than those in mild asphyxia group(t value was 3.267,2.849,5.738,1.648,9.894,5.028 and 3.264, respectively,all P<0.05).Ratio of first heart sound amplitude after crying to first heart sound amplitude in quiet time(S1/S1')in severe asphyxia group and mild asphyxia group was significantly lower than that in control group,while ratio of first heart sound amplitude to second heart sound amplitude(S1/S2)and ratio of diastolic time limit to sys tolic time limit(D/S)in asphyxia newborns were significantly higher than those in control group(t value was 8.364,5.729 and 1.748,respectively,all P<0.05). S1/S2 in severe asphyxia group was significantly higher than that in mild asphyxia group but D/S and S1/S1'were lower(t value was 2.947,9.084 and 5.385 respectively,all P<0.05).Regression analysis showed that LDH,CK and CK-MB were significantly correlated with CCR(OR value was 1.047,3.298 and 2.199,respectively,all P<0.05).Conclusion To understand the changing of CCR and the relationship of myocardial enzymogram and CCR could provide some evidence for predicting myocardial damage in asphyxia neonates and passing perinatal period safely.It is worthy of promotion in clinics.%目的 探讨心力储备对预测窒息新生儿心肌损害的价值.方法 选取于2014年11月至2016年11月在成都市妇女儿童中心医院住院的新生儿155例,其中105例新生儿患有窒息心肌损害,55例重度窒息作为重度窒息组,50例轻度窒息作为轻度窒息组;另外50例为健康新生儿作为健康对照组.根据心音测量的有关成分的幅值和时限计算心力储备(CCR)测试数据,另外取侧股外周静脉血分析新生儿血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、谷草转氨酶(AST)、肌钙蛋白Ⅰ(cTnⅠ)水平并分析心肌酶谱和CCR的相关性.结果 与健康对照组相比,轻度窒息组和重度窒息组新生儿CK、CK-MB、cT nⅠ 的水平显著增高,且重度新生儿显著高于轻度新生儿(t值分别为3.267、2.849、5.738、1.648、9.894、5.028、3.264,均P<0.05);轻度窒息组和重度窒息组在啼哭后第一心音幅值与安静时第一心音幅值的比值(S1/S1')明显低于健康对照组,而第一心音幅值与第二心音幅值的比值(S1/S2)、舒张期时限与收缩期时限的比值(D/S)明显高于健康对照组(t值分别为8.364、5.729、1.748,均 P<0.05);重度窒息组婴儿S1/S2比值明显高于轻度窒息组,D/S、S1/S1'比值显著低于轻度窒息组,差异具有统计学意义(t值分别为2.947、9.084、5.385,均 P<0.05).经回归分析发现LDH、CK和CK-MB与婴幼儿CCR呈显著相关性(OR值分别为1.047、3.298、2.199,均P<0.05).结论 认识窒息新生儿心力储备变化动态以及心肌酶谱和CCR的相关性能为及时发现窒息后发生心肌损害提供依据,为患儿安全度过围生期提供依据,值得在临床上推广.