多普勒超声监测新生儿窒息患儿肾血流动力学变化

发布时间：2018-09-07 22:26

【摘要】：目的探讨多普勒超声在新生儿窒息患儿肾功能损害的早期诊断、病情监测和疗效评估等临床应用中的价值。方法选取60例出生时间在24h内的新生儿,根据新生儿出生后1min Apgar评分将其分为重度窒息组(Apgar评分0~3分)、轻度窒息组(Apgar评分4~7分)和正常对照组(Apgar评分8~10分)。在新生儿出生后24h内、第3、7、10天,运用多普勒超声技术检测各组新生儿双侧肾动脉的收缩期峰值血流速度(PSV)、舒张期末血流速度(EDV)及阻力指数(RI)。同时采样血液标本,测定血清胱抑素C(sCysC)水平。结果与正常对照组比较,出生后24h内轻度及重度窒息组肾动脉PSV、EDV均不同程度降低(P均0.05),RI不同程度升高(P均0.05)。轻度窒息组PSV在出生后第3天已基本恢复正常,EDV、RI在出生后第10天已基本恢复正常,与正常对照组比较差异无统计学意义(P0.05);重度窒息组出生后第10天PSV、EDV、RI与正常对照组仍有显著差异(P均0.05)。3组新生儿随日龄增加sCysC均呈下降趋势。轻度窒息组新生儿出生后24h内、第3天sCysC水平较正常对照组明显升高(P均0.05),第7天、第10天与正常对照组比较差异无统计学意义(P均0.05);各日龄重度窒息组患儿sCysC水平均较正常对照组明显升高(P均0.05)。各组新生儿PSV、EDV与sCysC呈负相关;RI与sCysC呈正相关。结论多普勒超声检测肾动脉血流动力学参数能早期准确地反映窒息新生儿肾功能状态。
[Abstract]:Objective to evaluate the value of Doppler ultrasound in the early diagnosis, monitoring and evaluation of renal function in neonates with asphyxia. Methods 60 newborns with birth time within 24 hours were selected and divided into severe asphyxia group (Apgar score 0 ~ 3), mild asphyxia group (Apgar score 4 ~ 7) and normal control group (Apgar score 8 ~ 10) according to postnatal 1min Apgar score. The peak systolic velocity (PSV),) and resistance index (RI).) of renal arteries were measured by Doppler echocardiography within 24 hours after birth and 10 days after birth. The blood flow velocity (EDV) and resistive index (RI).) were measured at the end of diastolic period. At the same time, blood samples were collected and serum cystatin C (sCysC) levels were measured. Results compared with the normal control group, the PSV,EDV of renal artery in mild and severe asphyxia group decreased in different degree (P 0.05), and increased in different degree (P 0.05) in the mild and severe asphyxia group within 24 hours after birth. In mild asphyxia group, PSV returned to normal on the 3rd day after birth. Compared with the normal control group, there was no significant difference (P0.05); the PSV,EDV,RI of the severe asphyxia group was still significantly different from that of the normal control group on the 10th day after birth (P 0.05). The sCysC of the neonates in the severe asphyxia group showed a decreasing trend with the increase of age. The level of sCysC in mild asphyxia group was significantly higher than that in control group within 24 hours after birth on the 3rd day (all P 0. 05). There was no significant difference between the 10 th day and the normal control group (P 0. 05), and the level of sCysC in the severe asphyxia group was significantly higher than that in the normal control group (P 0. 05). There was a negative correlation between PSV,EDV and sCysC and positive correlation between RI and sCysC. Conclusion the renal artery hemodynamic parameters measured by Doppler ultrasound can accurately reflect the renal function of asphyxia neonates.
【作者单位】：西南医科大学附属医院超声诊断科;
【基金】：泸州市科技创新苗子培育计划项目[2013-R-51(12/18)]
【分类号】：R445.1;R722.12

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