正常中、晚孕期胎兒右心室功能的超聲定量研究
發(fā)布時間：2019-06-15 19:48
【摘要】：目的:應(yīng)用組織多普勒速度顯像(tissue velocity imaging,TVI)測定正常中晚孕胎兒三尖瓣環(huán)運動頻譜,即收縮期及舒張早、晚期峰值速度,與右心室常用測量指標(biāo)進(jìn)行相關(guān)性研究,分析其評價右心室收縮及舒張功能的可行性,以及其隨孕周的變化規(guī)律。應(yīng)用解剖M型超聲心動圖(free angle M-mode,FAM)測量中晚孕正常不同孕周的胎兒三尖瓣環(huán)收縮期位移(fetal-tricuspid annular plane systolic excursion,f-TAPSE),分析其作為評估右心室收縮及舒張功能指標(biāo)的應(yīng)用價值以及隨孕周的變化規(guī)律,并建立正常胎兒中孕組、晚孕組f-TAPSE的測量值參考范圍。方法:選取135例常規(guī)胎兒超聲檢查未發(fā)現(xiàn)心臟及其他器官畸形,孕婦除外糖尿病、高血壓等妊娠并發(fā)癥,并且產(chǎn)婦有準(zhǔn)確的停經(jīng)史,或與超聲檢查估算的孕周相符合的胎兒,根據(jù)不同孕周分為4組:20-24+6d周,25-29+6d周,30-34+6d周,35-40周。應(yīng)用TVI測量胎兒三尖瓣環(huán)收縮期峰值速度(myocardial tissue systolic velocity,Sa)以及舒張早期峰值速度(myocardial tissue early diastolic velocity,Ea)、舒張晚期峰值速度(myocardial tissue late diastolic velocity,Aa),將Ea、Aa、Sa與右心室功能常用測量指標(biāo):三尖瓣口舒張早期峰值流速(peak ventricular velocity,E)、舒張晚期峰值流速(peak atrial velocity,A)、肺動脈峰值血流速度(peak systolic velocity,PSV)、右心室每搏輸出量(right ventricular stroke volume,RV-SV)以及右心室射血分?jǐn)?shù)(right ventricular ejection fraction,RVEF)進(jìn)行相關(guān)性分析;并應(yīng)用M型超聲于三尖瓣環(huán)水平測量f-TAPSE,分析其隨孕周的變化規(guī)律,以及其與右心室功能常用測量指標(biāo)的相關(guān)性。不同孕周(gestational age,GA)組間f-TAPSE及右室功能常用測量指標(biāo)的比較采用單因素方差分析,各因素間的相關(guān)性分析采用Pearson相關(guān)分析。結(jié)果:1.正常中晚孕胎兒常規(guī)右心室測量指標(biāo)E、A、PSV、RV-SV均隨著孕周增長而增加,且E/A比值隨孕周逐漸增加趨近于1,但RVEF隨孕周變化不明顯。2.正常中晚孕胎兒不同孕周組間Ea、Aa、Ea/Aa、Sa組間比較差異均具有統(tǒng)計學(xué)意義(P=0.000),均隨著孕周的增長而升高,整個孕期內(nèi)Ea/Aa比值由0.41±0.08(20孕周)增加到0.73±0.03(40孕周),且Ea/Aa始終1,這與三尖瓣口血流速度測值E/A比值變化相一致,二者具有明顯相關(guān)性。并且多普勒測值Ea、Aa與右心室舒張功能指標(biāo)E、A具有良好的相關(guān)性,Sa與右心室收縮功能指標(biāo)PSV、RV-SV具有良好相關(guān)性。3.正常中晚孕胎兒不同孕周組間f-TAPSE組間比較差異具有統(tǒng)計學(xué)意義,其與E、Ea、Sa、PSV、RV-SV等右心室功能常用指標(biāo)測值呈顯著正相關(guān)(P0.05),但與RVEF組間比較差異不具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:組織多普勒技術(shù)的應(yīng)用為胎兒心功能的測定提供了一個全新的方法,其測量方法簡便快捷,一個頻譜即可綜合反映心室的收縮及舒張功能。由于測量的是三尖瓣的機械運動,它可以減少瓣口血流充盈方式的不同(如心率、前負(fù)荷的改變)而出現(xiàn)的差異,可廣泛應(yīng)用。f-TAPSE同樣可以作為定量反映胎兒右心室舒張及收縮功能的指標(biāo)。f-TAPSE的測量簡便、快捷,對儀器和技術(shù)要求不高,且本研究得出了中晚孕組f-TAPSE的參考值范圍,中孕組f-TAPSE參考值范圍:3.21~6.12,晚孕組f-TAPSE參考值范圍:4.74~9.68。
[Abstract]:Objective: To study the frequency spectrum of the tricuspid ring in the normal middle and late pregnant fetus by tissue Doppler velocity imaging (TVI), that is, the systolic and early diastolic, the late peak velocity, and the common measurement index of the right ventricle. The feasibility of evaluation of right ventricular systolic and diastolic function and its variation with the gestational week were analyzed. In this paper, the systolic and systolic displacement (f-TAPSE) of the fetal tricuspid valve in the normal and different gestational weeks was measured by using the anatomic M-mode (FAM), and the application value of the index of the right ventricular contraction and the diastolic function and the change of the gestational week were analyzed. And a reference range of the measurement values of the normal fetus, the pregnant group and the late pregnancy group f-TAPSE was established. Methods:135 cases of normal fetal ultrasound were selected to detect the pregnancy complications of heart and other organs, except for pregnant women, such as diabetes, hypertension, etc., and the pregnant women had accurate stop history, or the fetus that was in accordance with the gestational weeks estimated by the ultrasonic examination, divided into 4 groups according to different gestational weeks:20-24 + 6d, 25-29 + 6d,30-34 + 6d,35-40 weeks. The systolic peak velocity (Sa) and early diastolic peak velocity (Ea) and the late diastolic peak velocity (Aa) were measured by TVI, and the common measurement indexes of Ea, Aa, Sa and right ventricular function were measured: The early diastolic peak velocity (E), peak systolic velocity (A), peak systolic velocity (RV-SV), and right ventricular ejection fraction (RV-SV), and right ventricular ejection fraction (RV-SV), the early diastolic peak velocity (E), the peak systolic velocity (PSV), the right ventricular stroke volume (RV-SV), and the right ventricular ejection fraction (RV-SV), RVEF was used to measure f-TAPSE at the level of tricuspid annulus, and its relationship with the common measurement index of right ventricular function was analyzed. A single-factor analysis of variance was used for the comparison of f-TAPSE and right ventricular function in different gestational age (GA) groups, and Pearson correlation analysis was used for the correlation analysis between the factors. Results:1. The normal right ventricular measurement index E, A, PSV and RV-SV of the normal middle-and-late-pregnant fetus increased with the increase of the gestational period, and the E/ A ratio gradually increased with the gestational period to 1, but the change of the RVEF with the gestational period was not obvious. The differences of Ea, Aa, Ea/ Aa and Sa between the different gestational weeks of the normal and late-pregnant fetuses were of statistical significance (P = 0.000). The Ea/ Aa ratio increased from 0.41-0.08 (20 weeks) to 0.73-0.03 (40 weeks) during the whole pregnancy, and Ea/ Aa was always 1, This is consistent with the change of the E/ A ratio of the blood flow velocity of the tricuspid valve. And the Doppler measurement values Ea and Aa have good correlation with the right ventricular diastolic function indexes E and A, and the Sa and the right ventricular systolic function index PSV and the RV-SV have good correlation. The difference of f-TAPSE between the different gestational weeks of the normal and late-pregnant women was statistically significant, which was positively correlated with the common index values of the right ventricular function such as E, Ea, Sa, PSV, RV-SV (P0.05), but the difference between the two groups was not statistically significant (P0.05). Conclusion: The application of tissue Doppler technique provides a new method for the determination of fetal heart function. Because of the measurement of the mechanical movement of the tricuspid valve, it can reduce the difference in the blood flow filling method of the orifice (such as heart rate, change of the previous load), and can be widely used. F-TAPSE can also be used as a quantitative indicator of the right ventricular diastolic and systolic function of the fetus. F-TAPSE was simple and fast to measure, and the requirement of f-TAPSE was not high, and the reference range of f-TAPSE was 3.21-6.12, and the reference range of f-TAPSE was 4.74-9.68 in the late-pregnant group.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.1;R714.5
[Abstract]:Objective: To study the frequency spectrum of the tricuspid ring in the normal middle and late pregnant fetus by tissue Doppler velocity imaging (TVI), that is, the systolic and early diastolic, the late peak velocity, and the common measurement index of the right ventricle. The feasibility of evaluation of right ventricular systolic and diastolic function and its variation with the gestational week were analyzed. In this paper, the systolic and systolic displacement (f-TAPSE) of the fetal tricuspid valve in the normal and different gestational weeks was measured by using the anatomic M-mode (FAM), and the application value of the index of the right ventricular contraction and the diastolic function and the change of the gestational week were analyzed. And a reference range of the measurement values of the normal fetus, the pregnant group and the late pregnancy group f-TAPSE was established. Methods:135 cases of normal fetal ultrasound were selected to detect the pregnancy complications of heart and other organs, except for pregnant women, such as diabetes, hypertension, etc., and the pregnant women had accurate stop history, or the fetus that was in accordance with the gestational weeks estimated by the ultrasonic examination, divided into 4 groups according to different gestational weeks:20-24 + 6d, 25-29 + 6d,30-34 + 6d,35-40 weeks. The systolic peak velocity (Sa) and early diastolic peak velocity (Ea) and the late diastolic peak velocity (Aa) were measured by TVI, and the common measurement indexes of Ea, Aa, Sa and right ventricular function were measured: The early diastolic peak velocity (E), peak systolic velocity (A), peak systolic velocity (RV-SV), and right ventricular ejection fraction (RV-SV), and right ventricular ejection fraction (RV-SV), the early diastolic peak velocity (E), the peak systolic velocity (PSV), the right ventricular stroke volume (RV-SV), and the right ventricular ejection fraction (RV-SV), RVEF was used to measure f-TAPSE at the level of tricuspid annulus, and its relationship with the common measurement index of right ventricular function was analyzed. A single-factor analysis of variance was used for the comparison of f-TAPSE and right ventricular function in different gestational age (GA) groups, and Pearson correlation analysis was used for the correlation analysis between the factors. Results:1. The normal right ventricular measurement index E, A, PSV and RV-SV of the normal middle-and-late-pregnant fetus increased with the increase of the gestational period, and the E/ A ratio gradually increased with the gestational period to 1, but the change of the RVEF with the gestational period was not obvious. The differences of Ea, Aa, Ea/ Aa and Sa between the different gestational weeks of the normal and late-pregnant fetuses were of statistical significance (P = 0.000). The Ea/ Aa ratio increased from 0.41-0.08 (20 weeks) to 0.73-0.03 (40 weeks) during the whole pregnancy, and Ea/ Aa was always 1, This is consistent with the change of the E/ A ratio of the blood flow velocity of the tricuspid valve. And the Doppler measurement values Ea and Aa have good correlation with the right ventricular diastolic function indexes E and A, and the Sa and the right ventricular systolic function index PSV and the RV-SV have good correlation. The difference of f-TAPSE between the different gestational weeks of the normal and late-pregnant women was statistically significant, which was positively correlated with the common index values of the right ventricular function such as E, Ea, Sa, PSV, RV-SV (P0.05), but the difference between the two groups was not statistically significant (P0.05). Conclusion: The application of tissue Doppler technique provides a new method for the determination of fetal heart function. Because of the measurement of the mechanical movement of the tricuspid valve, it can reduce the difference in the blood flow filling method of the orifice (such as heart rate, change of the previous load), and can be widely used. F-TAPSE can also be used as a quantitative indicator of the right ventricular diastolic and systolic function of the fetus. F-TAPSE was simple and fast to measure, and the requirement of f-TAPSE was not high, and the reference range of f-TAPSE was 3.21-6.12, and the reference range of f-TAPSE was 4.74-9.68 in the late-pregnant group.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.1;R714.5
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