| Pneumonia refers to the inflammation in lungs which is aroused by different pathogens or other factors such as inbreathing amniotic fluid, oil or hypersusceptibility. It is very common in paediatrics and it often appears among infants. The infants with severe pneumonia will suffer from respiratory system symptoms, together with acute heart failure, myocarditis, respiratory failure, septicemia and apparent electrolytic disturbance, etc. Infant severe pneumonia is an important factor leading to death.Severe pneumonia may lead to acute heart failure, a serious syndrome. Many researchers and doctors have paid much attention to the changes of the functions of heart among the infants with severe pneumonia. To study the affections on the functions of heart is an important task. At present, the researchers from home and abroad have various points of view on their different researching conclusions. So it is quite significative to make further research and estimate the functions of heart of the infants with severe pneumonia impersonally and accurately.Planar echocardigraphy and color Doppler echocardigraphy are frequent ways to get impersonal and accurate result. Tei index is a newly developed ultrasonic measurement technique. The measurement results with that can not be affected by some factors, such as poor acoustical transmission and changes of heart rate and heart's preload and afterload. With the characteristics such as handiness, high sensitivity and with good repeatability, it can be used to evaluate the systolic function and diostolic function of the left ventricle and the right ventricle synthetically.In this disquisition, by using color Doppler echocardiography and Tei index, the heart function of 40 infants with severe pneumonia was measured. Aim: to get new material for further investigation on the affections on the hear functions by infant severe pneumonia; to evaluate the effect and significance on instructing clinical work of using color Doppler echocardiography and Tei index in clinical diagnosis and treatment to judge heart functions of infant with severe pneumonia.Research subjects and methods:Severe pneumonia group: 40 infants with severe pneumonia-21male, 19 female, at the age of 1 to 36 months, the average age is 1.2 year.Normal group: 40 healthy infants-26 male, 14 female, at the age of 1 to 36 months, the average age is 1.5 year.Instrument: PHILIP IE33 Color Ultrasonic Diagnostic Instrument. By using color Doppler echocardiography and Tei index, the parameters of heart function of two groups was measured. Test items: LVDd, LVSd, left ventricle ejection fraction (EF), fractional shortening (FS), right ventricle ejection fraction (EF), FS; acceleration time of aortic valve blood flow; acceleration time of pulmonary arterial valve blood flow; speed of blood stream at E peak value and A peak value in mitral valve tricuspid valve; IRT of left ventricle and the right ventricle as well as Tei index.Conclusion:1. LVDd of the severe pneumonia group got smaller, and the acceleration time of aortic valve blood flow was shortened. There were significant differences between the two groups (P<0.05); Left ventricular ejection fraction (EF) and fractional shortening (FS) decreased. There were very significant differences between the two groups (P<0.01).2. RVDd of the severe pneumonia group got bigger. There were significant differences between the two groups (P<0.05); The acceleration time of pulmonary arterial valve blood flow was shortened. There were very significant differences between the two groups (P<0.01); Right ventricular ejection fraction (EF) decreased. There were significant differences between the two groups (P<0.05).3. The speed of blood stream at E peak value in mitral valve got faster, the speed at A peak value of the group of infant severe pneumonia and the A/E ratio got lower. But there were no significant differences between the two groups (P>0.05).4. The speed of blood stream of the group of infant severe pneumonia at A peak value in tricuspid valve got higher, and there were very significant differences between the two groups (P<0.01); The A/E ratio in tricuspid valve got higher. There were significant differences between the two groups (P<0.05). The speed of blood stream at E peak value in tricuspid valve decreased, but there were no significant differences between the two groups (P>0.05).5. In the group of infant severe pneumonia, Tei index increased in both left and right ventricular. ICT of left and right ventricular increased. IRT of left ventricular increased. There were significant differences between the two groups (P<0.05). IRT of right ventricular increased. There were very significant differences between the two groups (P<0.01).Discussion:1. The infants with severe pneumonia usually appear systolic dysfunction. Respiratory dysfunction often appears together with severe pneumonia and arouses absence of oxygen and acidosis. Absence of oxygen and acidosis will lead to cardiac muscle damage. In the process of myocardial contractility, both the transportation and inversion of Ca and the work of ultramicroscopic filaments consume energy. So enough energy supply is necessary to make myocardial contractility work normally.When absence of oxygen happens, reduced oxygen to the cardiac muscle, aerobic oxidation dysfunction and the reduce of energy will lead to myocardial contractility fail or even can't contract. Besides absence of oxygen and acidosis, pathogen and its toxin and a great deal of medium of inflammation lead to cardiac muscle damage and suppression directly, and it is also one of the main factors leading to heart failure for pneumonia. Rising pulmonary artery pressure makes right ventricular afterload higher, and it is also a main factor leading to right ventricular systolic dysfunction.2. The result of Doppler test shows: There is no apparent change on left ventricular diastolic function when the infant severe pneumonia happens, while right ventricular diastolic function decreases. Tei index shows left and right ventricular diastolic function damage appears among the infant with severe pneumonia. To analyze according to the two test results, it is sure that right ventricular diastolic function is damaged. Left ventricular diastolic function is probably lightly damaged.Tei index may be more precise to tell the changes of diastolic function of heart. The main reason of ventricular diastolic function decrease when infant severe pneumonia happens is cardiac muscle damage lead by absence of oxygen, acidosis and toxemia. The existence of pulmonary hypertension makes apparent decrease of right ventricular diastolic potential energy, and it is a reason why right ventricular diastolic function is damaged rather seriously.3. In this disquisition, Tei index is first used to estimate the functions of heart of the infants with severe pneumonia. Tei index can show systolic function and diastolic function at the same time. This method is simple, has good repeativity, and in the meanwhile, it isn't affected by age, weight, sex, heart rate, preload and afterload of ventricular, or geometrical forms of ventricular.Tei index has great advantages in estimating right ventricular function. The shape of right ventricular is irregular and its motion is eccentric. It is complex to operate traditional echocardiography to measure right ventricular function, so the result might be not accurate. But Tei index is not affected by geometrical forms of ventricular and it is convenient to operate as well as accurate to estimate right ventricular function. So Tei index has great advantages in estimating heart function of infant with severe pneumonia.Not only this disquisition but also many others show: Left and right ventricular diastolic function damage appears among the infants with severe pneumonia. So it's significant to know the condition of heart function in clinical diagnosis and treatment. Echocardiography is an important and unimpeachable method, especially, Tei index can be used to get more information of the condition of heart function. |
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