超声监测三尖瓣反流胎儿脐动脉及静脉导管血流频谱参数的临床价值
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摘要
目的探讨不同程度单纯三尖瓣反流胎儿脐动脉(umbilical artery,UA)及静脉导管(ductus venous,DV)血流频谱参数变化及临床价值。方法选取孕20～41~(+6)周孕妇253例(除外心内及心外畸形),根据三尖瓣反流程度不同分为:轻度反流组68例,中度反流组20例,无三尖瓣反流胎儿165例为对照组。获取各组UA和DV血流频谱。测量胎儿UA血流频谱参数:收缩期峰值流速,舒张末期流速,计算收缩期峰值流速与舒张末期流速比值(peak systolic velocity/end diastolic velocity,S/D)、阻力指数(resistence index,RI)、搏动指数(pulsatility index,PI)。测量DV血流频谱参数:心室收缩期峰值流速,心室舒张期峰值流速,心房收缩期峰值流速,计算心室收缩期峰值流速与心房收缩期峰值流速比值(peak ventricular systolic velocity/peak atrial systolic velocity,S/A)、RI及PI。对比各组胎儿上述参数。结果轻度反流组UA血流频谱参数S/D、RI及PI和DV血流频谱参数S/A、RI及PI与对照组差异均无统计学意义(P>0.05),中度反流组UA血流频谱参数S/D、RI及PI和DV血流频谱参数S/A、RI、PI均较对照组及轻度反流组增高,差异均有统计学意(P<0.05)。结论 UA及DV血流频谱参数能够评价三尖瓣反流胎儿及胎盘情况,可为临床及时采取相应干预措施提供重要的依据。
Objective To investigate the changes and clinical value of blood flow spectrum parameters of umbilical artery(UA) and ductus venous(DV) in fetuses with tricuspid regurgitation at different degrees. Methods Two hundreds and fifty-three fetuses(20-41~(+6)week without structural defects) were divided into 3 groups: 68 cases with mild tricuspid regurgitation(mild group), 20 cases with moderate tricuspid regurgitation(moderate group) and 165 normal fetuses(control group). The blood flow spectrum of UA and DV in each group was obtained. The parameters of UA: peak systolic velocity(S), end diastolic velocity(D), S/D ratio, resistance index(RI) and pulsatility index(PI) were measured. Then the parameters of DV peak ventricular systolic velocity(S), peak atrial systolic velocity(A), S/A ratio, RI and PI were measured. Finally, conduct comparative analysis among the three groups was used. Results There was no significant difference in S/D, RI, PI of UA and S/A, RI and PI of DV between mild reflux group and control group(P>0.05). The parameters of UA blood flow spectrum S/D, RI, PI and DV in moderate reflux group were higher than those in control group and mild reflux group(P<0.05). Conclusion UA and DV blood flow spectrum can be used to evaluate the condition of fetus and placenta when tricuspid regurgitation happens. Therefore, it can provide substantial support for intervening measures.
Objective To investigate the changes and clinical value of blood flow spectrum parameters of umbilical artery(UA) and ductus venous(DV) in fetuses with tricuspid regurgitation at different degrees. Methods Two hundreds and fifty-three fetuses(20-41~(+6)week without structural defects) were divided into 3 groups: 68 cases with mild tricuspid regurgitation(mild group), 20 cases with moderate tricuspid regurgitation(moderate group) and 165 normal fetuses(control group). The blood flow spectrum of UA and DV in each group was obtained. The parameters of UA: peak systolic velocity(S), end diastolic velocity(D), S/D ratio, resistance index(RI) and pulsatility index(PI) were measured. Then the parameters of DV peak ventricular systolic velocity(S), peak atrial systolic velocity(A), S/A ratio, RI and PI were measured. Finally, conduct comparative analysis among the three groups was used. Results There was no significant difference in S/D, RI, PI of UA and S/A, RI and PI of DV between mild reflux group and control group(P>0.05). The parameters of UA blood flow spectrum S/D, RI, PI and DV in moderate reflux group were higher than those in control group and mild reflux group(P<0.05). Conclusion UA and DV blood flow spectrum can be used to evaluate the condition of fetus and placenta when tricuspid regurgitation happens. Therefore, it can provide substantial support for intervening measures.
引文
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[16] 裘品丹,袁晓丹,谢旭敏.11～13+6周胎儿静脉导管血流频谱异常在胎儿染色体异常和心脏畸形评估中的作用[J].现代医用影像学,2018,27(2):364-367.
[17] 曹云云,曾敏,孔晓晓,等.胎儿静脉导管血流频谱参数在晚孕期妊娠期糖尿病中的初步研究[J].临床超声医学杂志,2018,20(3):214-215.
[18] 王晓玲,王思思,刘晓燕.中孕期静脉导管多普勒血流参数预测胎儿生长受限的临床应用[J].医学影像学杂志,2017,27(9):1835-1837.
[2] 宋卫华.胎儿三尖瓣返流超声心动图评价及临床意义[J].影像研究与医学应用,2017,1(2):142-143.
[3] Chen K,Akoma U,Anderson A,et al.Prenatally diagnosed single umbilical artery:The role and relationship of additional risk factors in the fetus for congenital heart disease[J].J Clin Ultrasound,2016,44(2):113-117.
[4] 陈杰,吴立明,蔡敏.妊娠糖尿病孕妇胎儿脐动脉频谱血流收缩期最大血流速度和舒张期血流速度的比值与胎儿宫内窘迫的相关性[J].临床医学,2017,37(12):86-87.
[5] Predojevic M,Talic A,Stanojevic M,et al.Assessment of motoric and hemodynamic parameters in growth restricted fetuses-case study[J].J Matern Fetal Neonatal Med,2014,27(3):247-251.
[6] Rani S,Huria A,Kaur R.Prediction of perinatal outcome in preeclampsia using middle cerebral artery and umbilical artery pulsatility and resistance indices[J].Hypertens in Pregnancy,2016,35(2):210-216.
[7] Cirik DA,Taskim EA,Karcaaltincaba D,et al.Study of uterine and fetal hemodynamics in response to labor induction with dinoprostone in prolonged pregnancies with normal amniotic fluid and oligohydramnios[J].J Matern Fetal Neonatal Med,2014,27(7):691-695.
[8] 张陈彦,肖学茹,刘慧,等.胎儿脐动脉舒张末期血流缺失与母婴结局的病情观察与分析[J].河北医科大学学报,2016,37(8):975-978.
[9] 张黎,吴忠新.脐血流与胎心监护联合监测胎儿宫内窘迫的临床价值[J].现代医药卫生,2014,30(23):3576-3578.
[10] 陈江红,王娜,黄乃磊,等.胎儿脐动脉与大脑中动脉阻力指标在预测胎儿缺氧中的应用价值[J].河北医科大学学报,2016,37(12):1432-1436.
[11] 孙聪欣,张爱红,王露芳,等.超声动态监测胎儿脐动脉舒张末期血流缺失的临床意义[J].中华超声影像学杂志,2015,24(8):726-728.
[12] 黄嘉诚,王义成,杨瑞敏,等.右心室Tei指数联合静脉导管指数评价脐绕颈胎儿右心室功能[J].中国超声医学杂志,2017,33(3):238-240.
[13] 任伟利,王义成,杨贺,等.Tei指数联合静脉导管相关参数及三尖瓣环位移评价孕晚期羊水过少胎儿右心功能[J].中国超声医学杂志,2018,34(2):161-164.
[14] 郝晓一,李路明.中晚孕胎儿静脉导管a波反向的临床价值[J].中国超声医学杂志,2015,31(1):41-43.
[15] 邓学东.胎儿静脉导管监测的研究进展[J/CD].中国产前诊断杂志:电子版,2014,6(3):16-19.
[16] 裘品丹,袁晓丹,谢旭敏.11～13+6周胎儿静脉导管血流频谱异常在胎儿染色体异常和心脏畸形评估中的作用[J].现代医用影像学,2018,27(2):364-367.
[17] 曹云云,曾敏,孔晓晓,等.胎儿静脉导管血流频谱参数在晚孕期妊娠期糖尿病中的初步研究[J].临床超声医学杂志,2018,20(3):214-215.
[18] 王晓玲,王思思,刘晓燕.中孕期静脉导管多普勒血流参数预测胎儿生长受限的临床应用[J].医学影像学杂志,2017,27(9):1835-1837.