孕中晚期正常胎儿静脉频谱形态和血流动力学变化及其与胎儿右心功能的相关性研究

摘要

目的：采用彩色多普勒超声评价孕中晚期正常胎儿静脉频谱形态和血流动力学变化，探讨其与胎儿右心功能的相关性。方法收集2013年7月至2014年7月于本院产检的500例健康孕妇彩色多普勒超声检查数据，记录并总结不同孕周胎儿腔静脉血流情况和三尖瓣瓣口血流速度，分析腔静脉频谱峰值、三尖瓣血流频谱与孕周的相关性。结果胎儿上、下腔静脉内径及显示长度与孕周呈正相关（P＜0.01）；S波、D波及A波流速均随孕周的增大而增加（P＜0.05）；下腔静脉与上腔静脉血流频谱形态相似，但方向相反，下腔静脉血流速度略高于上腔静脉；孕中晚期正常胎儿三尖瓣瓣口血流速度E峰＜A峰，E峰血流速度随孕周增加而增大，而A峰血流速度变化不明显，E/A值与孕周呈正相关（P＜0.01）；三尖瓣瓣环Ea值随孕周增加而增加，呈线性正相关（P＜0.01）；上腔静脉D波速度与三尖瓣E峰、Ea峰呈正相关，A波速度与三尖瓣A峰值呈正相关，上腔静脉D/A与三尖瓣E/A值呈正相关，下腔静脉D波速度与三尖瓣E峰、Ea峰呈正相关，A波速度与三尖瓣A峰值呈正相关，下腔静脉D/A与三尖瓣E/A值呈正相关，下腔静脉与右心功能参数的相关趋势同上腔静脉（P＜0.01）。结论彩色多普勒超声观察孕中晚期正常胎儿腔静脉血流情况，可进一步判断其右心功能，胎儿腔静脉可伴随孕周增加发生血流动力学变化，腔静脉内径与血流速度也随之增加，在评价正常胎儿右心功能方面具有一定科学性，但右心功能异常评价指标尚未明确，需进一步研究。%ObjectiveTo evaluate ultrasonic spectrum of vena cava and haemodynamic alteration of the normal fetus of middle-late pregnancy by ultrasonic Doppler detector and explore the relationship between these indexes with right cardiac function.MethodData of 500 cases of healthy pregnant women received color Doppler ultrasound scanning from July 2013 to July 2014 in our hospital were collected. Different gestational fetus venous blood flow situation and tricuspid valve blood flow velocity were recorded and summarized. The correlation between peak value of vena cava spectrum, tricuspid valve lfow spectrum and gestational age were compared.ResultFetus superior and inferior vena cava diameter and display length were positively correlated with gestational age (P<0.01); lfow velocity of S, D and A wave increases with gestational age (P<0.05); blood spectrum morphology of inferior vena cava was similar with superior vena cava, while, in the opposite direction. The lfow velocity of inferior vena cava was slightly higher than superior vena cava. E peak of tricuspid lfow velocity was lower than A peak in normal middle-late pregnancy fetus. Flow velocity of E peak increased with gestational age, while that of A peak didn’t obviously change. Thus the E/A ratio was positively correlated with gestational age (P<0.01); tissue Doppler image showed that Ea values of tricuspid ring increase along with gestational age, with a linear positive correlation (P<0.01); D wave velocity, Ea and tricuspid E peak superior vena cava were positively correlated. A wave velocity was positively related with tricuspid A peak. Superior vena cava D/A and tricuspid E/A ratio were positively correlated (P<0.01). And so was the inferior vena cava.ConclusionObservation of the blood lfow in fetus vena cava by Doppler imaging can further judge the right cardiac function. Hemodynamic changes of fetal vena cava associated with gestational age, along with the increase of vena cava diameter and blood lfow velocity. It shows some potential in evaluating the right cardiac function of normal fetus. However, further research needs to be done to ifnd a proper index to detect abnormal the right cardiac function.