本文關鍵詞：中晚期妊娠胎兒肺動脈射血加速時間測定及其臨床意義　出處：《山東大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 胎兒 肺動脈血流加速時間(AT) 三尖瓣反流 彩色超聲心動圖

【摘要】：目的：利用彩色多普勒超聲對中晚期妊娠胎兒心臟肺動脈血流頻譜中的相關參數,如：肺動脈加速時間(AT)、右心室排血時間(ET)、肺動脈加速時間比右心室排血時間(AT/ET)、肺動脈收縮壓(PASP)等的測定,并對觀察組的三尖瓣反流速度,三尖瓣反流壓力階差等與AT進行相關性分析,試圖證明AT是診斷胎兒肺動脈壓高低的敏感指標。方法：本研究使用美國產Philips -iu22及IE33彩色多普勒超聲儀,研究對象：選取31例中晚期妊娠孕婦(除外先心病可能的檢測到有不同程度三尖瓣反流的胎兒)作為觀察組,隨機選取68例妊娠中晚期孕婦(胎兒經嚴格篩查無三尖瓣反流、無先心病等疾患)作為對照組,獲得兩組的肺動脈收縮壓(PASP)、右室排血時間(ET)、肺動脈血流加速時間(AT),AT/ET值。觀察組檢測三尖瓣反流速度(TRV)、三尖瓣反流壓力階差(PG),部分病例還檢測了動脈導管(DU)、DU速度、右肺動脈血流加速時間(RPA-AT)等參數,絕大多數患兒出生后進行了1天～62天的隨訪。兩組數據均采用SPSS17漢化數理統(tǒng)計包進行統(tǒng)計學處理。結果：觀察組AT為47.6±5.0ms；對照組AT為54.3±9.8ms 兩組P0.0001統(tǒng)計學相差非常顯著。觀察組AT與三尖瓣反流程度(TR)做相關分析,二者呈負相關(r=-0.426,P=0.0170.05)相差顯著。AT/ET值與TR亦呈負相關關系,且相關關系密切(r=-4.79,P=0.006)。AT值與孕婦年齡,孕周無明顯相關關系；TR與孕周、年齡也無相關性。肺動脈收縮壓PASP與AT呈負相關(r=-0.53 P0.01)；PASP與AT/ET也呈負相關(r=-0.52 P0.01)。胎兒出生后經1-62天的隨訪結果顯示絕大多數患兒三尖瓣反流明顯好轉或消失。結論：通過以上結果分析提示：中晚期妊娠胎兒肺動脈射血加速時間(AT)及其與右心室排血時間比(AT/ET)與三尖瓣反流程度、反流速度、反流壓差及肺動脈收縮壓均呈負相關；說明AT測值越小,提示肺動脈收縮壓越高,三尖瓣反流程度也越嚴重。AT值可以作為一項新指標預測胎兒肺動脈壓升高的程度,這一新指標尤其對沒有三尖瓣反流但存在肺動脈壓有增高的胎兒肺動脈壓的檢測更具有應用價值。
[Abstract]:Objective: the use of color Doppler ultrasound in pregnancy fetal heart and pulmonary arterial flow spectrum in the relevant parameters, such as: for advanced pulmonary artery acceleration time (AT), right ventricular ejection time (ET), pulmonary artery acceleration time than right ventricular ejection time (AT/ET), pulmonary artery systolic pressure (PASP) determination etc. and the observation group, three tricuspid regurgitation velocity, three tricuspid regurgitation gradient and correlation analysis with AT, trying to prove that AT is a sensitive index for the diagnosis of fetal pulmonary artery pressure. Methods: This study used the Philips -iu22 and IE33 color Doppler ultrasound, the research object: a total of 31 pregnant women (except to the detection of CHD may have different degrees of tricuspid regurgitation in three fetuses) as the observation group, randomly selected 68 cases of pregnant women in late pregnancy (fetal screening by strict three tips regurgitation, congenital heart disease and other diseases) as the control group, obtained two groups of pulmonary artery systolic pressure (PASP), right ventricular ejection time (ET), pulmonary artery acceleration time (AT), AT/ET value. In the observation group, three cusp regurgitation velocity (TRV) and three cusp regurgitation pressure gradient (PG) were detected. In some cases, arterial catheter (DU), DU velocity and right pulmonary artery blood flow acceleration time (RPA-AT) were detected in some cases. Most children were followed up for 1 days to 62 days after birth. The two groups of data were statistically processed by SPSS17 Sinicization mathematical statistics package. Results: the AT in the observation group was 47.6 + 5.0ms, and the AT in the control group was 54.3 + 9.8ms two groups, and the difference between the P0.0001 statistics was very significant. The correlation analysis was made between the observation group AT and the three apex regurgitation (TR), and the negative correlation (r=-0.426, P=0.0170.05) was significant in the two groups. The AT/ET value also has a negative correlation with TR, and the correlation is close (r=-4.79, P=0.006). There was no significant correlation between AT value and pregnant women's age and gestational age, and there was no correlation between TR and gestational age and age. The systolic pressure of pulmonary artery was negatively correlated with AT (r=-0.53 P0.01), and PASP was negatively correlated with AT/ET (r=-0.52 P0.01). After 1-62 days of follow-up, the results showed that most of the three apex regurgitation improved or disappeared in most of the children. Conclusion: through the analysis of the above results suggest: in late pregnancy fetal pulmonary ejection acceleration time (AT) and right ventricular ejection time ratio (AT/ET) and three tricuspid valve regurgitation, regurgitation velocity, reflux pressure and pulmonary artery systolic pressure were negatively correlated with AT values smaller; prompt, pulmonary artery systolic pressure is higher, the more severe tricuspid valve regurgitation is three. The AT value can be used as a new index to predict the degree of fetal pulmonary hypertension. This new index is especially valuable for the detection of fetal pulmonary artery pressure without the presence of three cusp regurgitation but with increased pulmonary artery pressure.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R714.5;R445.1

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本文編號：1345753