探讨右室内径与左室舒张末期内径比值(RVD/LVEDD)，以及右室收缩期压力与左室收缩期压力比值(RVSP/LVSP)等相关心室指标，对新生儿危重型肺动脉瓣狭窄(CPS)的诊断价值。

选择2016年1月至2018年11月，在青岛市妇女儿童医院接受经皮球囊肺动脉瓣成形术(PBPV)的28例单纯性CPS新生儿为研究对象，将其纳入CPS组。同时，随机选择由于低氧血症加重，于新生儿期在同一家医院接受PBPV的27例中度肺动脉瓣狭窄(MPS)患儿作为对照，纳入MPS组。采用彩色多普勒超声心动图，测量RVD及LVEDD值；采用右心导管插入术，测量RVSP值。对2组肺动脉瓣狭窄(PS)患儿一般临床资料及相关心室指标，采用t检验进行统计学比较；对RVD/LVEDD与右室收缩期压力(RVSP)的相关性，采用直线相关分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求，与所有受试儿的监护人签署临床研究知情同意书。

① CPS组患儿年龄及血氧饱和度分别为(4.6±4.1) d、(82.3±3.7)%，均小于或低于MPS组患儿的(14.6±3.0) d、(84.7±3.5)%，并且差异均有统计学意义(t＝—9.932、P<0.001，t＝—2.503、P＝0.015)。② CPS组患儿的RVSP、RVSP/LVSP及RVD/LVEDD分别为(97.5±7.1) mmHg(1 mmHg＝0.133 kPa)、(1.15±0.16)及(0.70±0.05)，均高于或大于MPS组患儿的(69.9±5.7) mmHg、(0.85±0.11)及(0.56±0.07)，并且差异均有统计学意义(t＝15.912、10.582、8.823，均为P<0.001)。③本研究所有PS新生儿的RVD/LVEDD与RVSP呈线性正相关关系(r＝0.706，P<0.001)。

彩色多普勒超声心动图获取的RVD/LVEDD值，对于临床初步评估新生儿CPS，具有一定指导价值。RVSP/LVSP值接近1.0，为诊断新生儿CPS的重要参考。

To investigate diagnostic values of critical pulmonary stenosis (CPS) in neonates by ratio of right ventricular diameter to left ventricular end-diastolic diameter (RVD/LVEDD) and ratio of right ventricular systolic pressure to left ventricular systolic pressure (RVSP/LVSP).

From January 2016 to November 2018, a total of 28 neonates with simple CPS who were underwent percutaneous balloon pulmonary valvuloplasty (PBPV) in Qingdao Women and Children′s Hospital, were chosen as research subjects and enrolled in CPS group. Meanwhile, a total of 27 neonates with moderate pulmonary stenosis (MPS) who received PBPV because of aggravation of hyoxemia in the same hospital during neonatal period, were enrolled in MPS group as control. RVD and LVEDD were measured by color Doppler echocardiography, and values of RVSP were measured by right cardiac catheterization. General clinical data and related ventricular indicators between two groups of neonates with pulmonary stenosis (PS) were compared statistically by t test. The correlation between RVD/LVEDD and right ventricular systolic pressure (RVSP) was analyzed by linear correlation analysis. The procedure followed in this study was in accordance with World Medical Association Declaration of Helsinki revised in 2013. Informed consents of clinical research were signed by guardians of all subjects.

①The age and oxygen saturation of neonates in CPS group were (4.6±4.1) d and (82.3±3.7)%, respectively, which were younger or lower than those of (14.6±3.0) d and (84.7±3.5)% in MPS group, and the differences were statistically significant (t=—9.932, P<0.001; t=—2.503, P=0.015). ② RVSP, RVSP/LVSP and RVD/LVEDD of neonates in CPS group were (97.5+ 7.1) mmHg (1 mmHg=0.133 kPa), (1.15±0.16) and (0.70±0.05), respectively, which were higher or larger than those of (69.9±5.7) mmHg, (0.85±0.11) and (0.56±0.07) in MPS group, and the differences were statistically significant (t=15.912, 10.582, 8.823, all P<0.001). ③There was linear and positive correlation between RVD/LVEDD with RVSP of all PS neonates in this study (r=0.706, P<0.001).

The values of RVD/LVEDD obtained by color Doppler echocardiography have certain guiding value for preliminary evaluation and identification of neonatal with CPS in clinical work. The RVSP/LVSP value close to 1.0 is an important reference to diagnose neonates with CPS.