本文選題：胎兒心臟 + 肺靜脈��； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：探討正常中晚孕期單胎胎兒肺靜脈血流流速曲線的變化規(guī)律及肺靜脈血流流速曲線改變對(duì)胎兒心臟結(jié)構(gòu)異常的診斷價(jià)值。 材料與方法：收集2013年1月至2014年5月在我院進(jìn)行中晚孕期產(chǎn)前超聲篩查且正規(guī)產(chǎn)檢的所有單胎胎兒，從中選取正常中晚孕期胎兒295例作為正常對(duì)照組，心臟結(jié)構(gòu)異常胎兒95例作為異常組。采用Philips iE33彩色多普勒超聲診斷儀分別對(duì)兩組胎兒行常規(guī)產(chǎn)科超聲檢查和心臟超聲檢查，測(cè)量胎兒肺靜脈血流流速曲線參數(shù)（S、D、A、Vmean、VTI），并根據(jù)S、D、A、Vmean計(jì)算S/D、PI、PVI，觀察并記錄超聲檢查表現(xiàn)。分析正常對(duì)照組胎兒左、右肺靜脈血流流速曲線形態(tài)特點(diǎn)，肺靜脈血流流速曲線參數(shù)與孕周的相關(guān)性，并比較左、右肺靜脈血流流速曲線參數(shù)間差異有無(wú)統(tǒng)計(jì)學(xué)意義。分析心臟結(jié)構(gòu)異常組胎兒肺靜脈血流流速曲線形態(tài)改變規(guī)律及與心臟結(jié)構(gòu)異常的關(guān)系。 結(jié)果：295例正常對(duì)照組胎兒左右肺靜脈血流流速曲線形態(tài)相似呈三相波，均包含S、D、A波。S/D1者：左肺靜脈250例（占84.7%），右肺靜脈251例（占85.1%）；S/D 1者：左肺靜脈36例（占12.2%），右肺靜脈36例（占12.2%）；S/D=1者：左肺靜脈9例（占3.1%），右肺靜脈8例（占2.7%）。胎兒肺靜脈血流流速曲線A波在多數(shù)胎兒表現(xiàn)為正向波，少數(shù)缺失，未發(fā)現(xiàn)反向波，其中A波正向者左肺靜脈284例（占96.3%），右肺靜脈282例（占95.6%），A波缺失者左肺靜脈11例（占3.7%），右肺靜脈13例（占4.4%）。胎兒左、右肺靜脈血流流速曲線參數(shù)S、D、A、Vmean、VTI與孕周呈正相關(guān)，S/D、PI、PVI與孕周無(wú)明顯相關(guān)關(guān)系。 心臟結(jié)構(gòu)異常組95例胎兒中12例肺靜脈血流流速曲線A波缺失，包括7例左心梗阻性疾病，3例右心梗阻性疾病，2例間隔缺損；10例A波反向，包括5例左心梗阻性疾病，1例右心梗阻性疾病，1例間隔缺損，3例圓錐動(dòng)脈干畸形；4例肺靜脈血流流速曲線形態(tài)異常呈連續(xù)波形改變，，不隨左心房收縮而變化，4例均為完全性肺靜脈異位引流胎兒。 結(jié)論：胎兒肺靜脈血流流速曲線形態(tài)異常、A波缺失或A波反向時(shí)，可提示存在胎兒心臟結(jié)構(gòu)異常的可能，應(yīng)進(jìn)一步做胎兒心臟超聲檢查。肺靜脈血流流速曲線形態(tài)改變，呈連續(xù)波形不隨左心房的收縮而變化時(shí)，可提示胎兒存在肺靜脈異位引流的可能。檢測(cè)胎兒肺靜脈血流流速曲線對(duì)輔助診斷胎兒心內(nèi)結(jié)構(gòu)異常有一定臨床意義，建議可作為胎兒產(chǎn)前超聲檢查的觀察指標(biāo)。
[Abstract]:Objective: to investigate the changes of pulmonary venous flow velocity curve in single fetus and the diagnostic value of pulmonary vein flow velocity curve in fetal cardiac abnormalities. Materials and methods: from January 2013 to May 2014, all single foetus were screened by prenatal ultrasound in our hospital, and 295 normal fetuses were selected as normal control group. 95 fetuses with abnormal cardiac structure were used as abnormal group. Two groups of fetuses were examined by Philips iE33 color Doppler ultrasound instrument. The parameters of fetal pulmonary vein blood flow velocity curve were measured by routine obstetrical ultrasonography and echocardiography. To analyze the morphological characteristics of left and right pulmonary venous velocity curves and the correlation between the parameters of pulmonary vein flow velocity curve and gestational weeks in the normal control group, and to compare the difference between left and right pulmonary vein flow velocity curve parameters. Objective: to analyze the changes of fetal pulmonary venous flow velocity curve and its relationship with abnormal cardiac structure in patients with abnormal cardiac structure. Results the blood flow velocity curve of left and right pulmonary veins of 295 normal fetuses was similar to that of three-phase waves. All the three phase waves were found in the left pulmonary vein in 250 cases (84.7%) and the right pulmonary vein in 251 cases (85.1%). S / D 1: left pulmonary vein in 36 cases (12.2%), right pulmonary vein in 36 cases (12.2%), left pulmonary vein in 9 cases (3.1%), right pulmonary vein in 8 cases (2.7%). In most fetuses, A wave of flow velocity of fetal pulmonary vein showed positive wave, a few were missing, no reverse wave was found. There were 284 cases of left pulmonary vein (96.3%) with positive A wave, 282 cases (95.6%) of right pulmonary vein, 11 cases (3.7%) of left pulmonary vein with missing A wave, 13 cases (4.4%) of right pulmonary vein. The VTI parameters of left and right pulmonary veins were positively correlated with gestational weeks. Of 95 fetuses with abnormal cardiac structure, 12 cases were without A wave of pulmonary vein flow velocity curve, including 7 cases of left ventricular obstructive disease and 3 cases of right heart obstructive disease and 2 cases of septal defect in 10 cases of A wave reverse. Including 5 cases of left ventricular obstructive disease, 1 case of right heart obstructive disease, 1 case of septal defect, 3 cases of conical artery trunk malformation, 4 cases of anomalous pulmonary vein flow velocity curve showed continuous waveform changes. No change with left atrial contraction was found in all 4 cases with complete anomalous pulmonary venous drainage. Conclusion: the absence of A wave or the reverse of A wave in fetal pulmonary vein flow velocity curve may indicate the possibility of fetal heart structure abnormality, which should be further examined by fetal echocardiography. When the flow velocity curve of pulmonary vein changes in shape and the continuous waveform does not change with the contraction of left atrium, it may indicate the possibility of anomalous pulmonary venous drainage in fetus. Detecting the flow velocity curve of fetal pulmonary vein has a certain clinical significance in the diagnosis of fetal heart structure abnormality. It is suggested that it can be used as an observation index of fetal prenatal ultrasound examination.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.5

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