Research Of The Relationship Between Fetal Arterial Duct Hemodynamic Changes And Postpartum Neonatal Persistent Pulmonary Hypertension(PPHN)

Objective:To investigate the clinical study of prenatal ultrasound diagnosis of neonatal persistent pulmonary hypertension(PPHN).Methods:A total of 3742 pregnant women who received routine prenatal ultrasound examination in cangzhou central hospital from August 2017 to December 2018 were studied.85 cases of arterial catheter stenosis were selected preliminarily,all of them were single pregnancy,and pregnant women complicated with hypertension and diabetes,as well as congenital heart disease and history of medication that may lead to arterial catheter stenosis or early closure were excluded,such as method iv and right ventricular double outlet.A total of 56 cases met the final criteria,including 50 cases of ductal stenosis,6 cases of premature closure,42 cases of postpartum normal performance,and 14 cases of persistent pulmo-nary hypertension.Patients diagnosed with ductal stenosis or premature closure were divided into three groups according to the level of arterial catheter systolic flow rate.Group A was the patients with ductal systolic flow rate greater than 140cm/s and less than 200cm/s,group B was the patients with ductal arterial systolic flow rate greater than 200cm/s,and group C was the patients with ductal arterial flow rate undetected,namely,early closure.For early diagnosis of arterial catheter narrow or closed cases were followed up at echocardiography,observe whether arterial duct stenosis degree is further change.All cases diagnosed with arterial stenosis or early closure were followed up to postpartum echocardiography to observe the presence of persistent pulmonary hypertension in neonates and related treatment,and to analyze and compare the relationship between persistent pulmonary hypertension and the degree of arterial stenosis in neonates.Results:1.There were 7 cases of simple arterial stenosis in group A,and 23 cases with tricuspid regurgitation(5 of them had simultaneous right ventricular enlargement).After echocardiography,3 cases showed Persistent pulmonary hypertension;3 patients with simple arterial stenosis in group B,a total of 17patients with tricuspid regurgitation(right ventricular enlargement in 17 cases of tricuspid regurgitation),postoperative echocardiography Six patients had persistent pulmonary hypertension symptoms;in group C,6 patients had a significant increase in right ventricle,and the amplitude of movement was significantly reduced,accompanied by a large number of tricuspid regurgitation,followed up after birth,and 5 patients showed persistence.pulmonary hypertension.2.There was no significant difference in the gestational age and age of the subjects between the three groups(P>0.05),indicating that there was comparability between the three groups.3.The incidence of postpartum PPHN was different in three groups of patients with different degrees of arterial stenosis or early closure.There were statistical differences between the three groups(χ2=15.87,P=0.000),and the incidence of PPHN in group A and group B was compared.The difference was statistically significant(χ2=8.059,P=0.005).The difference between the A and C groups was statistically significant(χ2=15.56,P=0.000).4.There was a correlation between the degree of arterial stenosis and the degree of tricuspid regurgitation(Y=117.7lgX-248.8,R=0.9422,R~2=0.8877).The difference was statistically significant.There was a correlation between the degree of arterial stenosis and the degree of right ventricular enlargement(Y=2.071lgX-3.324,R=0.8680,R~2=0.7535),the difference was statistically significant..Conclusion:1.The incidence of idiopathic arterial stenosis was 1.5%,and the incidence of postpartum PPHN was 0.4%.The difference between the degree of arterial stenosis and PPHN was statistically significant,that is,as the degree of stenosis of the arterial catheter increased,postpartum The risk of developing PPHN is also increased,so arterial stenosis is a high risk factor for postpartum PPHN.2.To analyze the relationship between the degree of arterial stenosis and tricuspid regurgitation and right ventricular enlargement,it was found that the degree of tricuspid regurgitation and right ventricular enlargement increased with the increase of arterial stenosis..