新生儿期心室功能及血液动力学变化研究

发布时间：2018-04-05 01:03

  本文选题：新生儿　切入点：心室功能　出处：《安徽医科大学》2012年硕士论文

【摘要】：目的(1)利用超声心动图检测不同阶段新生儿左右心室功能及血液动力学参数；(2)分析对正常新生儿心室功能的影响因素； 方法采用Philips IE33彩色多普勒超声诊断仪检测100例正常新生儿左右心室功能,其中,足月儿45例,早产儿55例。测量指标包括：左心室收缩功能指标有主动脉瓣口峰值流速(AV)、每搏输出量(SV)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室短轴缩短率(LVSF)、左室射血分数(LVEF);右心室收缩功能指标有肺动脉瓣口峰值流速(PV)；左心室舒张功能指标有二尖瓣口舒张早期与舒张晚期血流充盈速度比(二尖瓣E/A,MVE/A);右心室舒张功能指标有三尖瓣口舒张早期与舒张晚期血流充盈速度比(三尖瓣E/A, TVE/A)。根据胎龄不同分成3组,即胎龄28-31+6、32-363+和37-41+6周,比较不同胎龄新生儿心室功能变化；根据心功能检查时日龄分成2组,即dl-d7和d8-d28,分别比较不同日龄的早产儿和足月儿心室功能变化；采用多元线性回归分析探讨影响新生儿心室功能的因素。 结果(1)左心室收缩功能：AV、SV、LVESV、LVEDV、LVSF与LVEF随胎龄增加而增加,且胎龄为28-313+与32-36++周组早产儿的AV、SV、LVESV、LVEDV、 LVSF与LVEF均低于37～41+6周组,差异有统计学意义(P均0.05)。另外,随日龄变化,早产儿中AV、SV、LVESV、LVEDV、LVSF与LVEF随之增加,组间比较差异有统计学意义(P均0.05)；足月儿LVSF与LVEF随之增加,组间比较有统计学意义(P0.05)；其余各项差异均无统计学意义(P均0.05)。 (2)右心室收缩功能：PV随胎龄增加而增加,且胎龄为28-313+及32-363+周早产儿组PV均低于胎龄为37-40+1周足月儿组,差异有统计学意义(P0.05)；早产儿中PV随日龄增加而增加,组间比较差异有统计学意义(P0.05);足月儿组间比较PV差异无统计学意义(P0.05)。 (3)左心室舒张功能：MVE/A随胎龄增加而增加,且胎龄为28-31+6及32-36+6周早产儿组PV均低于胎龄为37～40+1周足月儿组,差异均有统计学意义(P0.05)；早产儿中MVE/A随日龄增加而增加,组间比较差异有统计学意义(P0.05)；足月儿组间比较MVE/A差异不显著(P0.05)。 (4)右心室舒张功能：TVE/A随胎龄增加而增加,且胎龄为28-31+6及32-36+6周早产儿组PV均低于胎龄为37～40+6周足月儿组,差异有统计学意义(P0.05)；早产儿中TVE/A随日龄增加而增加,组间比较差异有统计学意义(P0.05)；足月儿组间比较TVE/A差异不显著(P0.05)。 (5)正常新生儿心室功能的影响因素：AV、PV、SV、LVSF、LVEF、MVE/A及TVE/A均与出生体重、胎龄、检查时日龄呈正相关(P均0.05)。另外,性别上,男婴AV明显高于女婴,差异有统计学意义(P0.05),其他各项指标比较无统计学意义(P均0.05)；各项指标与出生方式无关(P均0.05)。 结论(1)随胎龄的增大,新生儿左右心室收缩和舒张功能逐渐增强。 (2)新生儿生后左右心室收缩功能逐渐增强且左室收缩功能增加较右室明显；左室舒张功能也渐增强,但右室舒张功能增强不显著。 (3)早产儿心室舒缩功能均低于足月儿。 (4)出生体重、胎龄和日龄是影响新生儿心室功能的重要因素,而性别和出生方式不是影响心功能的主要参数。
[Abstract]:Objective ( 1 ) To detect left and right ventricular function and hemodynamics parameters in different stages by echocardiography .
( 2 ) influencing factors of normal neonatal ventricular function ;


Methods A Philips IE33 color Doppler ultrasonic diagnostic instrument was used to detect the left and right ventricular function in 100 normal neonates , including 45 cases of term infants and 55 premature infants . The measurement indexes include : the systolic function of left ventricle : the peak velocity of the aortic valve ( AV ) , the volume of each stroke ( SV ) , the end diastolic volume ( LVL ) of the left ventricle , the left ventricular end diastolic volume ( LVSF ) , the left ventricular ejection fraction ( LVEF ) , and the right ventricular systolic function index ( PV ) ;
The diastolic function of left ventricle was earlier than that of mitral valve E / A , MVE / A and tricuspid valve E / A , TVE / A . According to the gestational age , three groups were divided into three groups : gestational age 28 - 31 + 6 , 32 - 363 + and 37 - 41 + 6 weeks .
According to the cardiac function , the ventricular function changes of preterm infants and term infants with different age were divided into 2 groups , i.e . , dl - 7 and d8 - d28 , respectively .
Multivariate linear regression analysis was used to investigate the factors affecting neonatal ventricular function .

Results ( 1 ) Left ventricular systolic function : AV , SV , LVET , LVSF and LVEF were increased with the gestational age .
LVSF and LVEF increased with the increase of LVEF ( P0.05 ) .
There was no significant difference in the remaining differences ( P < 0.05 ) .

( 2 ) Right ventricular systolic function : PV increased with the gestational age , and the gestational age was 28 - 313 + and 32 - 363 + week premature infants group PV was lower than the gestational age at 37 - 40 + 1 week ( P0.05 ) .
In preterm infants , PV increased with age , and there was significant difference between groups ( P0.05 ) . There was no statistical significance between the groups in term infants ( P0.05 ) .

( 3 ) Left ventricular diastolic function : MVE / A was increased with the gestational age , and the PV of preterm infants with gestational age of 28 - 31 + 6 and 32 - 36 + 6 weeks was lower than that in gestational age of 37 锝，

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