超声心动图对正常胎儿主动脉峡部血流的频谱分析
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摘要
目的探讨超声心动图对正常胎儿主动脉峡部血流进行频谱分析的临床价值。方法随机选取2018年1月至2019年1月在本院门诊以及北京安贞医院"胎儿心脏病母胎医学研究北京重点实验室",行胎儿超声心动图检查的多中心数据库中,300例孕龄20～40周且随访结果为正常胎儿的超声心动图图像作为研究对象,对所有采取图像的主动脉峡部内径、主动脉峡部收缩早期流速、收缩末期流速、收缩末期持续时间、舒张早期流速、舒张中期流速、舒张末期流速以及手动描记血流频谱的RI值、PI值进行整理和分析。结果主动脉峡部收缩末期血流频谱主要有以下3种不同情况:①中孕晚期,主要表现为折线型,即基于基线对侧的极短暂反折线,其中舒张期和收缩期频谱血流流速均不为0;②晚孕早期,主要表现为凹陷型,即基于基线对侧的短暂反折波,其中舒张期和收缩期频谱血流流速均为0;③晚孕晚期,主要表现为逆向型,即基于基线对侧的明显的反向波峰,其中舒张期和收缩期频谱血流流速均为负数。随着正常胎儿孕周的增加,其主动脉峡部最大内径也呈现增加趋势,差异有统计学意义(P<0.05);进一步进行线性分析结果显示正常胎儿主动脉峡部最大内径与孕周之间存在明显的直线正相关(r=0.719,P<0.001)。随着孕周增加,正常胎儿的主动脉峡部心排出量呈现明显的上升趋势(P<0.05);进一步相关性分析结果显示主动脉峡部心排出量与孕周呈现明显正相关(r=0.369,P<0.001)。主动脉峡部收缩早期流速、收缩末期流速、收缩末期持续时间、舒张早期流速、舒张中期流速、舒张末期流速以及手动描记血流频谱的RI值、PI值均与孕周呈现直线正相关关系(P<0.05)。结论超声心动图对正常胎儿主动脉峡部血流频谱分析具有较高的应用价值,临床可据此对胎儿的心功能进行早期筛查。
Objective To investigate the clinical value of echocardiography in frequency spectrum analysis of normal fetal aortic isthmus blood flow. Methods 300 fetal echocardiographic images of normal fetuses aged 20-40 weeks were randomly selected as the study objects from the multicenter database of fetal echocardiography in the outpatient department of our hospital and the Beijing Key Laboratory of Maternal and Fetal Medical Research of Fetal Heart Disease in Beijing Anzhen Hospital from January 2018 to January 2019. The internal diameter of aortic isthmus, early systolic velocity, end systolic velocity, end systolic duration, early diastolic velocity, mid diastolic velocity, end diastolic velocity and RI and PI values of manual recording of blood flow spectrum were collated and analyzed. Results The end-systolic blood flow spectrum of the isthmus of the aorta can be divided into three different situations: ①In the third trimester of pregnancy, the main manifestation was broken line, which was based on the opposite side of the baseline. The blood flow velocity of the diastolic and systolic spectrum was not 0. ②In the early stage of late pregnancy, the main manifestation was depression, short-term reflex based on the opposite side of the baseline, in which the diastolic and systolic spectral blood flow velocities were both 0; ③In the late trimester of pregnancy, the main manifestation was reversal, the obvious reversal peak on the opposite side of the baseline, in which the diastolic and systolic spectral blood flow velocities were negative. With the increase of gestational weeks of normal fetuses, the maximum internal diameter of aortic isthmus also showed an increasing trend with statistical significance(P<0.05); Further linear analysis showed that there was a significant linear positive correlation between the maximum internal diameter of aortic isthmus and gestational weeks of normal fetuses(r=0.719, P<0.001). With the increase of gestational weeks, the cardiac output of aortic isthmus in normal fetuses showed an obvious upward trend(P<0.05); further correlation analysis showed that the cardiac output of aortic isthmus was positively correlated with gestational weeks(r=0.369, P<0.001). Early systolic velocity, end systolic velocity, end systolic duration, early diastolic velocity, mid-diastolic velocity, end diastolic velocity and RI and PI values of manual flow spectrum were positively correlated with gestational weeks(P<0.05). Conclusion Echocardiography is of great value in the analysis of blood flow spectrum in normal fetal aortic isthmus, and it can be used for early screening of fetal cardiac function.
Objective To investigate the clinical value of echocardiography in frequency spectrum analysis of normal fetal aortic isthmus blood flow. Methods 300 fetal echocardiographic images of normal fetuses aged 20-40 weeks were randomly selected as the study objects from the multicenter database of fetal echocardiography in the outpatient department of our hospital and the Beijing Key Laboratory of Maternal and Fetal Medical Research of Fetal Heart Disease in Beijing Anzhen Hospital from January 2018 to January 2019. The internal diameter of aortic isthmus, early systolic velocity, end systolic velocity, end systolic duration, early diastolic velocity, mid diastolic velocity, end diastolic velocity and RI and PI values of manual recording of blood flow spectrum were collated and analyzed. Results The end-systolic blood flow spectrum of the isthmus of the aorta can be divided into three different situations: ①In the third trimester of pregnancy, the main manifestation was broken line, which was based on the opposite side of the baseline. The blood flow velocity of the diastolic and systolic spectrum was not 0. ②In the early stage of late pregnancy, the main manifestation was depression, short-term reflex based on the opposite side of the baseline, in which the diastolic and systolic spectral blood flow velocities were both 0; ③In the late trimester of pregnancy, the main manifestation was reversal, the obvious reversal peak on the opposite side of the baseline, in which the diastolic and systolic spectral blood flow velocities were negative. With the increase of gestational weeks of normal fetuses, the maximum internal diameter of aortic isthmus also showed an increasing trend with statistical significance(P<0.05); Further linear analysis showed that there was a significant linear positive correlation between the maximum internal diameter of aortic isthmus and gestational weeks of normal fetuses(r=0.719, P<0.001). With the increase of gestational weeks, the cardiac output of aortic isthmus in normal fetuses showed an obvious upward trend(P<0.05); further correlation analysis showed that the cardiac output of aortic isthmus was positively correlated with gestational weeks(r=0.369, P<0.001). Early systolic velocity, end systolic velocity, end systolic duration, early diastolic velocity, mid-diastolic velocity, end diastolic velocity and RI and PI values of manual flow spectrum were positively correlated with gestational weeks(P<0.05). Conclusion Echocardiography is of great value in the analysis of blood flow spectrum in normal fetal aortic isthmus, and it can be used for early screening of fetal cardiac function.
引文
[1]陈倬,何怡华,李胜利,等.应用胎儿超声心动图STIC技术对胎儿主动脉缩窄的CFD血流动力学三维数值模拟研究[J].中国循环杂志,2016,31(1):124.
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[11]刘晓伟,陈倬,张烨,等.胎儿心脏主动脉弓反向血流的病理意义[J].中华围产医学杂志,2018,21(1):24-30.
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[13]马逸宜,刘小铭,朱栋晓,等.中晚期胎儿心排血量及其分布变化的超声观察[J].江苏医药,2016,42(20):2243-2246.
[14]孙慧,解丽梅.胎儿中晚孕期主动脉峡血流动力学变化规律研究进展[J].中国医学影像技术,2018,34(3):452-455.
[15]孔丹丹,吴小欢,刘慧君,等.主动脉缩窄胎儿超声心动图参数的特性研究[J].现代实用医学,2017,29(9):1231-1233.
[2]王爽,王雯雯,卢媛.胎儿超声心动图血流动力学参数在孕龄判断中的临床研究[J].吉林医学,2017,38(6):1069-1071.
[3]杨贵岚,罗友,王茜,等.超声心动图诊断胎儿双主动脉弓的临床价值[J].中国超声医学杂志,2016,32(8):764-766.
[4]孙雪,张颖,王彧,等.胎儿动脉导管异常的超声心动图检查及分析[J].中国医学影像技术,2017,33(5):731-734.
[5]陈倬,刘晓伟,韩建成,等.胎儿超声心动图对正常胎儿主动脉峡部血流频谱分析的研究[J].中华超声影像学杂志,2017,26(8):672.
[6] Kawamura H, Inamura N, Inoue Y, et al. Is retro‐grade blood flow of aortic isthmus useful for the prenatal screening of coarctation of the aorta by fetal color Doppler echocardiography? A preliminary study[J]. J Med Ultrason, 2017,45(3):1-5.
[7] Tynan D, Alphonse J, Henry A, et al. The Aortic Isthmus:A Significant yet Underexplored Watershed of the Fetal Circulation[J]. Fetal Diagn Ther, 2016,40(2):81-93.
[8] Garciacanadilla P, Crispi F, Cruzlemini M, et al.Understanding the Aortic Isthmus Doppler Profile and Its Changes with Gestational Age Using a Lumped Model of the Fetal Circulation[J]. Fetal Diagn Ther, 2016,41(1):41-50.
[9]范亚娟,褚雯,梁雅君,等.超声心动图检查左心室流出道梗阻解剖形态与血流动力学特征分析[J].现代医药卫生,2017,33(13):1940-1941.
[10]颜林淋,罗红缨,鲍永慧,等.多普勒超声监测多项血流参数评估胎儿生长受限及判断预后的研究[J].当代医学,2016,22(30):16-18.
[11]刘晓伟,陈倬,张烨,等.胎儿心脏主动脉弓反向血流的病理意义[J].中华围产医学杂志,2018,21(1):24-30.
[12]王锟,董凤群,贺新建,等.孕晚期正常胎儿产前产后主动脉弓峡部血流量参数值的建立[J].中国超声医学杂志,2016,32(11):1011-1014.
[13]马逸宜,刘小铭,朱栋晓,等.中晚期胎儿心排血量及其分布变化的超声观察[J].江苏医药,2016,42(20):2243-2246.
[14]孙慧,解丽梅.胎儿中晚孕期主动脉峡血流动力学变化规律研究进展[J].中国医学影像技术,2018,34(3):452-455.
[15]孔丹丹,吴小欢,刘慧君,等.主动脉缩窄胎儿超声心动图参数的特性研究[J].现代实用医学,2017,29(9):1231-1233.