新生儿窒息合并胎粪吸入综合征肾血流动力学的超声研究

doi:10.3969/j.issn.1671-7171.2017.03.018

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摘要【目的】探讨轻度窒息合并胎粪吸入综合征(MAS)新生儿肾脏血流动力学变化特点。【方法】选择2015年7月至2016年7月本院新生儿科收治的轻度窒息足月新生儿30例,根据其是否合并MAS将其分为非MAS组及MAS组,每组各15例。同时选择同期出生的健康足月新生儿16例作为对照组。所有新生儿均在出生后24 h内、d₃、d₇采集肾脏血流动力学数据,于其安静入睡状态下运用彩色多普勒探测双侧主肾动脉血流动力学参数,包括收缩期最大峰值流速(PSV)、舒张期最小流速(EDV)、阻力指数(RI)。【结果】非MAS组、MAS组患儿出生d1时PSV、EDV均低于对照组正常新生儿,RI均高于对照组,差异均具有统计学意义(均P＜0.05);MAS组患儿出生d₁时EDV低于非MAS组,RI均高于非MAS组,差异均具有统计学意义(均P＜0.05)。MAS组患儿出生d₃时PSV、EDV均低于非MAS组、对照组,差异均具有统计学意义。非MAS组、MAS组患儿出生d₇时PSV、EDV、RI与对照组比较,差异无统计学意义(均P＞0.05)。非MAS组出生后d1时PSV、EDV最低,RI最高,出生后d₃、d₇时PSV、EDV逐渐增高,RI逐渐减低,出生后d₁时PSV、EDV、RI与d₇比较,差异具有统计学意义(均P＜0.05);MAS组出生后d₁时PSV、EDV较低,RI最高,出生后d₃时PSV进一步减低,EDV稍升高,RI最低,出生后d₇时PSV、EDV、RI均升高,以PSV升高最明显,出生后d₁时PSV、EDV、RI与d₇比较,差异有统计学意义(P＜0.05);对照组三次测值PSV、EDV呈逐步升高趋势,RI呈减低趋势,但组内比较,差异无统计学意义(P＞0.05)。【结论】轻度窒息新生儿其肾供血减少,以EDV为甚,轻度窒息合并MAS时,肾血流减少更明显,且延续时间长,恢复慢,提示彩色多普勒超声可及时监测新生儿肾脏供血改变并为临床治疗提供参考依据。

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关键词 ：窒息, 新生儿/并发症, 胎粪吸入综合征/并发症, 肾动脉/超声检查, 超声检查, 多普勒, 血流动力学

Abstract：【Objective】To investigate the ultrasonographic characteristics of renal hemodynamics in mild asphyxia neonates with meconium aspiration syndrome (MAS). 【Methods】Thirty cases of full-term newborns with mild asphyxia from July 2015 to July 2016 in our hospital were collected for the research. According to whether or not they had meconium aspiration syndrome (MAS), the patients were divided into two groups: group A (15 cases without MAS) and Group B (15 cases with MAS). At the same time, 16 healthy full-term newborn infants were selected as group C (the control group). The hemodynamic parameters of the bilateral main renal artery were detected by color Doppler while the baby was sleeping quietly. Systolic peak systolic velocity (PSV), end - diastolic velocity (EDV) and resistance index (RI) were measured on d₁, d₃ and d₇ after birth. 【Results】The PSV and EDV values of group A and B on d₁ were lower than those of group C (P<0.05), while RI values were higher than that of group C (P<0.05). The EDV of group B on d₁ was lower than that of group A, and the RI was higher than that of group A (P<0.05). Both PSV and EDV of group B on d₃ were lower than those of group A and group C; the difference was statistically significant (P<0.05). There were no significant differences in PSV,EDV and RI on d₇ between group A and group B (P>0.05). The PSV and EDV of group A were the lowest and the RI was the highest on d₁ after birth, after which the PSV and EDV increased gradually while the RI decreased gradually on d₃ and d₇. Finally the differences of PSV,EDV and RI of group A between d₁ and d₇ were statistically significant (P<0.05). The PSV and EDV of group B were both low and RI was the highest on d₁, then the PSV on d₃ was further reduced while the EDV was slightly increased and RI became the lowest on d₃. On d₇, all of PSV, EDV and RI in group B were increased; PSV increased the most. The differences of PSV,EDV and RI of group B between d₁ and d₇ were statistically significant (P<0.05). In group C, PSV and EDV showed a tendency to increase gradually, while RI showed a decreasing tendency, but the different trends among them were not statistically significant(P＞0.05). 【Conclusion】In neonates with mild asphyxia, the renal blood supply is reduced. it is more obvious in diastolic (EDV). When accompanied with MAS, the renal blood flow decreases even more significantly, and it will last longer and take slower recovery. Our research suggested that color Doppler ultrasonography can detect the change of renal blood supply to provide useful information for clinical treatment.

Key words： Asphyxia Neonatorum/CO Meconium Aspiration Syndrome/CO Renal Artery/US Ultrasonography, Doppler Hemodynamics

收稿日期: 2017-01-06

PACS:

R722.12

引用本文:

胡文文;陈红天;夏晓辉;危安;刘亮;王群. 新生儿窒息合并胎粪吸入综合征肾血流动力学的超声研究[J]. 医学临床研究, 2017, 34(3): 471-474.
HU Wen-wen, CHEN Hong-tian, XIA Xiao-hui, et al. Ultrasonographic Study of Renal Hemodynamics in Neonates with Mild Asphyxia and Meconium Aspiration Syndrome. JOURNAL OF CLINICAL RESEARCH, 2017, 34(3): 471-474.

链接本文:

http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2017.03.018 或 http://www.jcr.net.cn/CN/Y2017/V34/I3/471

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