定量组织速度成像和Tei指数评价新生儿窒息合并心肌损伤的左心室功能

摘要

目的：探讨定量组织速度成像（QTVI）和Tei指数在评价新生儿窒息合并心肌损伤的左心室功能，指导临床治疗及评估预后的临床意义。方法回顾性36例健康顺产新生儿对照组（NN组）和72例新生儿窒息患儿的临床资料。结果 NN组、无心肌损伤临床征象的新生儿窒息组（NA-A组）与有心肌损伤临床征象的新生儿窒息组（NA-B组）24h内常规超声心动图参数左心房（LA）、左心室舒张末内径（LVEDD）、室间隔厚度（IVS）、左心室后壁厚度（LVPW）、左心室射血分数（EF）、左心室缩短率（FS）比较差异均无统计学意义（P>0.05）；二尖瓣口血流频谱E峰、A峰以及E/A在NN组与NA-A组间比较差异无统计学意义（P>0.05），而NA-B组的E峰和EA与NA-A组、NN组间比较差异均有统计学意义（P<0.01）。NA-B组和NA-A组的Sa、Ea、Ea/Aa均显著低于NN组（P<0.01），且NA-B组低于NA-A组（P<0.01）；Aa在NN组、NA-A组和NA-B组之间比较差异均无统计学意义（P>0.05）。NA-B组和NA-A组Tei指数均显著高于NN组（P<0.01），且NA-B组Tei指数亦显著高于NA-A组，差异有统计学意义（P<0.01）。NA组的E/A、A峰低于NA-B组，差异有统计学意义（P<0.01）。NA-C组的Sa、Ea、Ea/Aa以及Tei指数与NA-B组比较差异有统计学意义（P<0.01）。两组间Aa比较差异无统计学意义（P>0.05）。结论通过QTVI及Tei指数的联合应用可以敏感、准确的评价新生儿窒息的左心室功能，尤其能提高早期诊断轻度新生儿窒息中且临床未能发现的心肌损伤。对提高诊断及评估新生儿窒息合并心肌损伤疗效有临床指导意义。%ObjectiveTo investigate the clinical value of quantitative tissue velocity imagine and Tei index in assessment of left ventricular systolic and diastolic function in the neonate asphyxia combined with myocardial injury and analysis in the evaluation of clinical curative effect. Methods A retrospective review of 36 cases of healthy infants in control group(NN group)and the clinical data of 72 cases of neonatal asphyxia. Results 1.Mitral infow E velocity and E/A were significantly decrased in the NA-B compwere with the NA-A and the contral. There were no significant differences between the 4 groups in other conventional echocardiographic parameters.Sa、Ea、Ea/Aa were significantly decreased in the NA-B compwered with the control,Futhermore,Sa、Ea、Ea/Aa were significantly decreased in the NA-B compwered with the NA-A.the Aa was no significant differences between the 3 groups(NA-A、NA-B、control).QVTI-derived Tei index were significantly impaired in NA-A,NA-B with those of the contral’s,moreover,it signigicantly increase in the NA-B compwered with the NA-A. 2.Mitral infow E velocity and E/A were significantly increased in the NA-C compwere with the NA-B.There were no significant differences between the 2 groups(NA-B、NA-C)in other conventional echocardiographic parameters.Sa、Ea、Ea/Aa were significantly increased in the NA-C compared with the NA-B. there was no significant differences between the 2 groups for Aa. QVTI-derived Tei index were significantly increased in the NA-Ccompwered with the NA-B. Conclusion QVTI combined with Tei index is a sensitive and accurate tool to evaluate LV function in the full-term neonate asphyxia combined with myocardial injury. To improve the early diagnosis of myocardial injury in asphyxia newborn .and assessment the clinical curative effect.