正常胎儿心脏血流动力学超声测值及临床意义

摘要

目的 研究中晚孕期正常胎儿心脏二、三尖瓣血流特点,并探讨不同孕期血流特点的演变规律,为先天性心脏病的筛查提供诊断依据.方法 选146例孕19～40周正常胎儿为研究对象,PWD测量二、三尖瓣血流E峰、A峰,计算E/A值,把三尖瓣血流为单峰的分为组1,双峰的分为组2,比较两组间心率的差异.组2中把孕20～28周-分为A组,28周～40周分为B组,对A、B两组间E峰、A峰、E/A进行t检验,并对组内进行配对t检验,对各观察指标随孕周的变化分别进行分析.结果 组1的平均心率比组2高,两组间有统计学差异.A、B两组间,二尖瓣血流E峰、三尖瓣血流E峰、A峰及两组房室瓣的E/A值,B组均比A组高.二尖瓣血流A峰,A、B两组间无差异.在A、B两组内,两组房室瓣血流A峰均高于E峰,三尖瓣血流的E峰、A峰、E/A值均高于二尖瓣.两组房室瓣的E峰、A峰及E/A值均随孕周的增加而增加,但A峰随孕周改变变化较小.结论 应用超声检测,建立正常中晚孕期胎儿二、三尖瓣血流E峰、A峰、E/A值的正常值范围,研究其在不同孕期的演变规律,可为胎儿心功能不全、先天性心脏病的筛查提供有价值的诊断依据.%Objective To evaluate and describe the mitral and tricuspid valves flow characteristics by using ultro-sound technique in normal fetal heart, to explore the evolution of the flow characteristics of different stages of gestation and provide more basis for the screening of congenital heart disease. Methods 146 normal fetuses from 19 weeks to 40 weeks were examined. We measured E and A peak velocities and E/A ratio for both mitral and tricuspid valves by Doppler echocardiography. According to the tricuspid blood flow characteristics, a single peak is divided into group 1, two peaks are divided into group 2. We compared the heart rate differences between the two groups. In group 2, 20 to 28- weeks of gestation is divided into group A, 28 to 40 weeks of gestation is divided into Group B. E and A peak velocities and E/A ratio were compared using Independent-samples t-test between A and B groups, and compared using paired -samples t-test in the same group. Changes in the observed indicators with gestational age were analyzed. Results The average heart rate in group 1 was faster than that in group 2. There was significant differences between the two groups. Between the two groups (A, B) , E and A peak velocities of tricuspid, E peak of mitral, and the E/A ratio of the both at-rioventricular valve of group B were significantly higher than that of group B. There was no difference about A peak of mitral between the two groups. In the A and B two groups, we found significantly higher Doppler velocities for the tricuspid valve than for the mitral valve. Two sets of atrioventricular valve blood flow peak A was higher than the peak E. With the advance of gestation a significant linear increase in the E peak and E/A ratio were found for both mitral and tricuspid valves. A peak change with gestational age changed little. Conclusion This study provides an effective approach to diagnosis fetal heart function insufficiency and congenital heart disease .