摘要
目的观察雾化吸入硝酸甘油(NTG)对新生儿缺氧性心肌损害的保护作用。方法选择窒息新生儿65例,根据有无肺动脉高压分为实验组(NTG组)33例和对照组32例,复苏后NTG组给予雾化吸入NTG。治疗前后采用多普勒超声心动图监测各项心功能指标,以及检测血清中肌酸激酶心肌同工酶(CK-MB)和肌钙蛋白I(cTnI)的改变。结果 (1)NTG组NTG吸入后各项心功能指标显著上升。与吸入前比较,吸入后12～24h、48～72h,LVEF从(58.92±6.58)%升至(66.48±5.08)%、(70.22±4.96)%(P<0.01);FS从(29.09±4.37)%升至(34.30±3.79)%、(37.13±3.95)%(P<0.01);RVEF从(54.89±8.64)%升至(66.23±7.12)%、(68.72±5.98)%(P<0.01);二尖瓣E/A从0.93±0.18升至1.05±0.21、1.13±0.19(P<0.01);三尖瓣E/A从0.79±0.15升至1.06±0.27、1.07±0.21(P<0.01);对照组相同时点各项指标较基础状态均无改善,无统计学差异。(2)与对照组相比,NTG组基础状态下LVEF、FS、RVEF、二尖瓣E/A、三尖瓣E/A均明显低于对照组(P<0.01),12～24h后RVEF、三尖瓣E/A均高于对照组(P<0.05),LVEF、FS、二尖瓣E/A与对照组已无差异;48～72h后NTG组各项心功能指标均高于对照组(P<0.05)。(3)NTG组血清CK-MB在NTG吸入前为(94.25±26.11)IU/L,与对照组相仿,NTG吸入后CK-MB降为(34.88±8.56)IU/L,低于对照组;NTG组cTnI在NTG吸入前为(0.74±0.19)ng/ml,明显高于对照组,NTG吸入后cTnI降为(0.32±0.08)ng/ml,与对照组相仿。结论 NTG吸入能有效地减轻急性低氧性心肌损害,改善心功能。起效迅速,无明显毒副作用。
Objective Perinatal exposure to hypoxia is considered to be a cause of hypoxie-ischemic myocardial impairment in newborn associated with increase of pulmonary artery pressure and pulmonary vascular resistance.Recent studies suggest that inhaled nitric oxide(NO)may play an important role in the pathophysiology of pulmonary hypertension,and exert novel cardioprotection.But it's difficult to apply in practice because the cost is expensive and the operation is complicated.Nitroglycerin(NTG),as one of NO donors,can release NO and thereby provide a means of delivering NO to its site of action which is a potent vascular smooth muscle relaxant.The aim of the present study was to observe and evaluate the efficacy and security of inhalation of nebulized nitroglycerin on neonatal heart impairment induced by hypoxia.Methods A total of 65 neonates with hypoxia were divided into two groups according to pulmonary arterial pressure.NTG group(33 cases)with pulmonary hypertension was treated with inhaled nebulized nitroglycerin.The control group(32 cases) had no pulmonary hypertension.All the neonates underwent serial echocardiography evaluation before and during therapy to estimate the heart function,parameters included left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF),ratio of peak E velocity and peak A velocity of mitral flow and tricuspid flow(MV E/A and TV E/A),isovalumic relaxation time of left ventricle(IVRT),ratio of accelerative time of pulmonary artery and ejective time of right ventricle(AT/RVET),and detect the level of CK-MB and cTnI in serum before and 4 days after therapy.Results(1)In the NTG group,both of the diastolic function and systolic function of RV and LV ameliorated obviously after inhalation of nebulized nitroglycerin,especially RV function.Contrast to baseline,LVEF increased from(58.92±6.58)% to(66.48±5.08)% and(70.22±4.96)%,and FS from(29.09±4.37)% to(34.30±3.79)% and(37.13±3.95)%,RVEF from(54.89±8.64)% to(66.23±7.12)% and(68.72±5.98)%,MV E/A from 0.93±0.18 to 1.05±0.21 and 1.13±0.19,TV E/A from 0.79±0.15 to 1.06±0.27 and 1.07±0.21,at 12-24 hour,48-72 hour after initiation of treatment,respectively(P<0.01).In control group,there were no differences in the same time.(2)LVEF,FS,RVEF,MV E/A,TV E/A in NTG group were all lower than those in control group at initiation of inhalation,respectively(P<0.01);at 12-24 hour after initiation,the level of those parameter in NTG group all increased,and compared with those in control group,LVEF,FS,MV E/A had no difference,RVEF and TV E/A were higher,respectively(P<0.05);at 48-72 hour after initiation,the heart function were still improved and superior to control group(P<0.05).(3)The serum level of CK-MB in NTG group [(94.25±26.11)IU/L] was similar with control group at baseline,and decreased sharply after inhalation [(34.88±8.56)IU/L,P<0.01],which turned lower than it in control group 4 days later.Simultaneously,The level of cTnI in NTG group[(0.74±0.19)ng/ml] markedly higher than control group at baseline,decreased after initiation,and had no significant difference 4 days later[(0.32±0.08)ng/ml,P>0.05].Conclusions Inhaled nebulized nitroglycerin can reduce myocardial impairment induced by hypoxia and improve heart function in newborn,there are no tolerance or systemic effects at the dosage given in this report.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第16期4713-4717,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
心肌损害
缺氧
硝酸甘油
婴儿
新生
雾化
Myocardial impairment
Anoxia
Nitroglycerin
Infant,newborn
Nebulization
