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| 題 名 | Prognostic Value of Color Doppler Echocardiographic Findings in Premature Newborns with Patent Ductus Arteriosus=早產新生兒存開性動脈導管彩色超音波心圖所見之預後價值 |
|---|---|
| 作 者 | 沈慶村; 柯嘉音; 王南琨; | 書刊名 | 中華民國小兒科醫學會雜誌 |
| 卷 期 | 38:2 民86.03-04 |
| 頁 次 | 頁104-110+166 |
| 分類號 | 417.5261 |
| 關鍵詞 | 存開性動脈導管; 彩色都普勒血流圖; 右心室收縮時間間距; 經三尖瓣壓差; 早產新生兒; Patent ductus arteriosus; Doppler color flow maps; Systolic time interval of the right ventricle; Tricuspid valve gradient; Premature neonates; |
| 語 文 | 英文(English) |
| 中文摘要 | 自1989年壹月至1995年拾貳月在本院369位早產兒中,有196位在生後一週內做彩色及雙弧心臟超音波檢查,內容包括心臟輸出量,輸出率,左心房對主動脈口徑比,右心室收縮時間間距,經三尖瓣壓差,及存開性動脈導管之彩色都普勒心圖。其中有47位早產兒有存開性動脈導管,分成三組。A組15例的存開性動脈導管無心衰竭症狀,並且在一年的追蹤檢查中自行關閉。B組20例其心臟衰竭需用藥物或手術結紮動脈導管處置。C組12例因動脈導管有關的併發症導致死亡。其餘149例動脈導管已關閉之早產兒為對照組。結果發現存開性動脈導管的早產兒其右心室收縮時間間距較關閉者長 (0.26 ± 0.12對照0.18 ± 0.06, P<0.005)。經三尖瓣壓差較高 (30.50 ± 11.85對照 20.54 ± 6.88, 毫米汞柱, P<0.005),表示存開性對關閉性動脈導管之早產兒其平均及收縮肺動脈血壓較高。而因存開性動脈導管的併發症導致死亡的早產兒,較動脈導管於一年內自行關閉者,其懷孕週數較短 (29.46 ± 3.41對照32.80 ± 2.78 週, P<0.01),出生體重較輕 (1366.17 ± 684.28對照 2061.67 ± 751.77公克, P<0.01)。其彩色都普勒超音波心圖顯示其動脈導管較粗大,導管腰部較少縮小,由左向右血流較澎湃,而血流中較少渦流引起的多彩 (Mosaicism)。 |
| 英文摘要 | This study intended to evaluate the relationship between the prognosis for premature newborns (PM) with patent ductus arteriosus (PDA) and their Doppler echocardiographic findings. From January 1989 to December 1995, of 369 premature newborns in their first postnatal week, 196 underwent ductal evaluations echocardiographically; 47 of these 196 cases were found to have PDA. Each echocardiogram had complete data for cardiac output, ejection fraction, the left atrial-to-the-aortic ratio (LA/AO), the systolic time interval of the right ventricle ( RVSTI), the transvalvular pressure gradient from tricuspid regurgitation (TGTR) and ductal Doppler color flow maps. These 47 premature newborns with PDA were grouped into (A) “asymptomatic” patients whose ductus closed spontaneously within a one-year follow-up (15 subjects), (B) “symptomatic” patients whose ductus were closed by pharmacological or surgical managements (20 subjects), and (C) “complicated” patients whose ductus caused mortality of the host (12 subjects). The remaining 149 premature newborns with a closed ductus (CD) served as controls. The RVSTI in these 47 premature newborns with PDA was found to be significantly higher than those of 149 CD (0.26 ± 0.12 vs. 0.18 ± 0.06, p<0.005), and denoting that PM-PDA had a higher mean pulmonary arterial pressure. The TGTR of these 47 premature newborns with PDA was also higher than these of the 149 CD controls ( 30.50 ± 11.85mmHg vs. 20.54 ± 6.88 mmHg, p<0.005), denoting that PM-PDA had a higher pulmonary arterial systolic pressures. Gestational age of group C neonates was younger than group A (29.46 ± 3.41 weeks VS. 32.80 ± 2.78 weeks, P<0.01). The birth weight of Group C neonates was lower than that of Group A ( 1366.17 ± 684.28 gm vs. 2061.67 ± 751.77 gm, p<0.01), therefore, extreme prematurity and small-for-gestational-age could have increased the mortality of PM-PDA.Doppler color flow maps of group C showed a wider ductal patency, less ductal waist-narrowing, more vehement red-color forward flow and less midstream mosaicism. It was concluded that patient with extreme prematurity, with very-low-birth-weight or wider patent ductus, higher pulmonary hypertension, less midstream mosaicism, or less ductal waist-narrowing would have a poorer prognosis. |
本系統中英文摘要資訊取自各篇刊載內容。