86例宫内生长受限足月新生儿的左心结构及功能分析

Characteristics of the left heart structure and function in 86 term neonates with intrauterine growth restriction

摘要:

目的 分析宫内生长受限（intrauterine growth restriction, IUGR）足月新生儿的左心结构及功能特点。方法 选取2019年1月—2022年1月在首都医科大学附属北京友谊医院新生儿病房收治的86例IUGR足月新生儿为IUGR组，随机选取同期出生的86例非IUGR足月适于胎龄儿为非IUGR组，比较分析两组新生儿临床数据及超声心动图结果。结果 两组新生儿左心结构及功能分析显示，IUGR组新生儿的左心室质量、左室舒张末期内径、左室收缩末期内径、左房内径、舒张末期室间隔厚度、左室后壁厚度、左室舒张末期容积、左室收缩末期容积、每搏输出量低于非IUGR组（P<0.05），舒张末期室间隔相对厚度（舒张末期室间隔厚度与左室后壁厚度比值）、二尖瓣血流E峰与A峰比值≥1比例、心脏指数则高于非IUGR组（P<0.05）。Spearman秩相关分析结果显示，每搏输出量与出生体重及体表面积呈正相关（分别r_s=0.241、0.241，P<0.05），舒张末期室间隔相对厚度与出生体重及体表面积呈负相关（分别r_s=-0.229、-0.225，P<0.05）。结论 IUGR新生儿左心室的收缩功能与非IUGR新生儿无明显差异。IUGR新生儿的室间隔相对更厚，此变化与出生体重及体表面积呈负相关。IUGR新生儿存在左心室舒张功能受损的情况。

Abstract:

Objective To study the left heart structure and functional characteristics of term neonates with intrauterine growth restriction (IUGR).Methods This study included 86 term neonates with IUGR admitted to the Neonatal Ward of Beijing Friendship Hospital, Capital Medical University from January 2019 to January 2022 as the IUGR group, as well as randomly selected 86 term neonates without IUGR born during the same period as the non-IUGR group. The clinical data and echocardiographic data were compared between the two groups.Results The analysis of left heart structure and function showed that compared with the non-IUGR group, the IUGR group had significantly lower left ventricular mass, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, end-diastolic interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume, left ventricular end-systolic volume, and stroke volume (P<0.05) and significantly higher ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness, proportion of neonates with a mitral peak E/A ratio of ≥1, and cardiac index (P<0.05). The Spearman correlation analysis suggested that stroke volume was positively correlated with birth weight and body surface area (r_s=0.241 and 0.241 respectively; P<0.05) and that the ratio of end-diastolic interventricular septal thickness to left ventricular posterior wall thickness was negatively correlated with birth weight and body surface area (r_s=-0.229 and -0.225 respectively; P<0.05).Conclusions The left ventricular systolic function of neonates with IUGR is not significantly different from that of neonates without IUGR. However, the ventricular septum is thicker in neonates with IUGR. This change is negatively correlated with birth weight and body surface area. The left ventricular diastolic function may be impaired in neonates with IUGR.