출생 초기 중증 대사 산증이 있는 신생아에서의 심근 손상
Myocardial Injury in Newborn Infants with Severe Metabolic Acidosis at the First Day of Life
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목적: 다양한 원인에 의해 나타나는 중증 산증(acidosis)은 심근 손상(myocardiac injury)에 의한 심장 기능 부전(cardiac dysfunction)을 비롯하여 여러 장기에 영향을 미치는 다기관 기능부전을 일으킨다. 본 저자들은 출생 초기 중증 산혈증(acidemia)이 있는 환아를 대상으로 심장 기능 저하에 대해 알아보았고, 산증의 종류와 정도에 따른 심장에 미치는 영향을 알아보고자 하였다. 방법: 재태주령 34주 이상이면서 출생 초기 혈액가스분석 결과 pH 7.2 미만인 환아를 대상으로 의무기록을 검토하여 후향적 조사를 하였다. 심장 기능 저하 소견으로 심근수축제 치료가 필요하였던 경우를 심장 기능 저하군(cardiac dysfunction, CD군)으로 정의하였고, 심근 손상 정도는 현장현시검사를 이용하여 다양한 심장 효소를 측정하여 비교 분석하였다. 전체 대상 환아에서 호흡 산증의 동반 여부를 기준으로 이산화탄소 농도 60 mmHg 이상을 RA군, 그렇지 않은 환아를 non-RA군으로 나누어 비교 분석하였고, 염기과잉 -10 미만을 severe BE군, 그렇지 않은 환아를mild BE군으로 분류하였다. 결과: 전체 대상 환아에서, CK-MB 농도와 myoglobin 농도는 염기과잉과 유의한 음의 상관관계를 보였다. CD군은 non-CD군보다 경련과 사망이 유의하게 많았으며, CK-MB와 cTnI의 농도가 유의하게 높았다. Severe BE군은 mild BE 군보다 심장 기능 저하와 경련이 있었던 경우가 많았고 CK-MB, myoglobin 그리고 cTnI 농도가 유의하게 높았다. Non-RA군은 RA군 보다 CK-MB와 myoglobin 농도가 유의하게 높았다. 결론: 출생 초기에 중증 대사 산증이 있는 신생아에서 심근 손상에 의한 심장 기능 저하가 많이 동반되므로, 이에 대한 적극적인 감시와 적절한 치료가 필요하겠다.
Abstract
Purpose: Severe acidosis by various causes can lead to multi-organ dysfunction including cardiac dysfunction (CD) due to myocardial injury. The aims of this study are to investigate CD in newborn infants with severe acidemia at the first day of life and to evaluate the effect on myocardial injury according to the type and the severity of acidosis. Methods: This was a retrospective study of infants ≥34 weeks of gestational age with severe acidemia (pH<7.2) at the first day of life. Infants treated by inotropics due to CD were defined as CD group. To evaluate myocardial injuries, various cardiac enzymes were measured using a commercial kit. RA group (pCO2>60 mmHg) and non-RA group (pCO2≤60 mmHg) were classified based on the presences of respiratory acidosis. Severe base excess (BE) group (BE<-10) and mild BE group (BE≥-10) were classified based on the degree of BE. Results: The levels of CK-MB and myoglobin had significant negative relation with BE. CD group had higher incidences of seizure and mortality and higher levels of CK-MB and cTnI than those of non-CD group. Severe BE group had higher incidences of CD and seizure and higher levels of CK-MB, myoglobin and cTnI than those of mild BE group. Non-RA group had higher levels of CK-MB and myoglobin than those of RA group. Conclusion: At the first day of life, the newborn infants with severe metabolic acidosis have high incidences of CD and myocardial injury. Aggressive monitoring and appropriate treatment for CD according to myocardial injury should be recommended in the newborn infants with severe metabolic acidosis.
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