發(fā)布時間：2018-01-15 04:09

  本文關(guān)鍵詞：組織多普勒成像技術(shù)及Tei指數(shù)評價臍繞頸胎兒及單純性單臍動脈胎兒右室功能的研究　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 臍帶繞頸胎兒 單純性單臍動脈胎兒 組織多普勒成像技術(shù) Tei指數(shù) 右室收縮功能 右室舒張功能

【摘要】：目的: 運用組織多普勒成像技術(shù)（Tissue Doppler Imaging，TDI）及Tei指數(shù)評價臍繞頸胎兒(umbilieal cord around neck，UCAN)及單純性單臍動脈胎兒（simple single umbilical artery SUA）的右室收縮功能和舒張功能，為臍繞頸及單純性單臍動脈胎兒的產(chǎn)前咨詢和臨床處理提供依據(jù)。 方法: 研究對象：選自孕齡23-40周（平均孕齡28.4±3.9周）的59名孕婦，孕婦年齡21-35歲（平均年齡27.3±4.0歲），共分為三組。 經(jīng)胎兒系統(tǒng)超聲確認(rèn)為臍帶繞頸但無胎兒宮內(nèi)窘迫，為臍帶繞頸組(A組)，共16例。平均孕齡28.4±3.4周，孕婦年齡21-30歲，平均年齡26.6±4.0歲；經(jīng)胎兒系統(tǒng)超聲檢查確認(rèn)為單純單臍動脈，為單臍動脈組(B組)，共15例。平均孕齡28.8±3.3周，孕婦年齡22-33歲，平均年齡26.9±4.1歲；經(jīng)胎兒系統(tǒng)超聲及胎兒超聲心動圖檢查，確認(rèn)無心內(nèi)外結(jié)構(gòu)畸形及宮內(nèi)發(fā)育遲緩，為正常對照組，共28例。平均孕齡28.2±3.8周，孕婦年齡21-35歲，平均年齡27.8±4.0歲；入選標(biāo)準(zhǔn)：首先是胎兒條件：早期均作過胎兒系統(tǒng)超聲檢查，證實胎齡與孕周相符；且經(jīng)過胎兒系統(tǒng)超聲及胎兒心動超聲篩查無心內(nèi)外結(jié)構(gòu)畸形及宮內(nèi)發(fā)育遲緩；其次是孕婦條件：經(jīng)詢問病史及以往體檢和查看孕婦保健記錄本和檢查結(jié)果，確認(rèn)孕婦身體健康，無吸煙、嗜酒史，無高血壓、糖尿病史，無心、肝、腎等慢性疾病史，無先心病生育史和家族史。無服用消炎痛等非甾體類抗炎藥物史。 使用儀器：使用GE VIVID E9型彩色多普勒超聲診斷儀，采用6S探頭,探頭頻率2.5-6MHz，該儀器具有TDI程序。 圖像儲存：平靜呼吸條件下，囑所有孕婦在平臥或側(cè)臥的舒適狀態(tài)下，選擇胎動不頻繁時在二維模式下獲取標(biāo)準(zhǔn)而清晰的胎兒四腔心切面，首先在普通二維模式下，打出清晰四腔心，將取樣容積置于三尖瓣口右室側(cè)， 啟動PW鍵，獲取連續(xù)5個以上的胎兒心動周期的舒張期三尖瓣口血流頻譜圖，儲存；其次同在二維模式下，啟動M型超聲功能鍵，將取樣線置于三尖瓣環(huán)與右室游離壁交界處，連續(xù)掃描5個以上的胎兒心動周期穩(wěn)定的三尖瓣環(huán)位移圖(Tricuspid annular plane systolic excursion TAPSE），儲存待以后分析。啟動TDI功能鍵，切換至脈沖多普勒（PW），將取樣線置于三尖瓣環(huán)與右室游離壁交界處，盡量使聲束與心肌縱向運動平行,連續(xù)掃描5個以上的胎兒心動周期穩(wěn)定的三尖瓣環(huán)組織多普勒頻譜圖，儲存待以后分析。最后，在二維模式下，打出清晰的肺動脈長軸切面，將取樣線置于肺動脈瓣上，啟動PW鍵，獲取連續(xù)5個以上的胎兒心動周期的收縮期肺動脈瓣口血流頻譜圖。 圖形分析及參數(shù)測量： 1三尖瓣口血流頻譜（PW）：測量三尖瓣口舒張舒張期早期峰值速度（E，cm/s）；舒張期晚期峰值速度（A，cm/s）；并計算E/A。將前一周期的A峰結(jié)束至下一周期E峰開始的時間間期記為（a，ms）。 2肺動脈瓣口血流頻譜（PW）：將收縮期肺動脈瓣血流峰值所占時間（射血時間ejection time, ET）記為（b，ms）;a-b為等容收縮期時間（isovolumetriccontraction time,ICT）與等容舒張期時間（isovolumetric relaxationtime,IRT）之和。 3右心室p-tei指數(shù)=（ICT+IRT）/ET；即右心室p-tei指數(shù)=（a-b）/b。 4三尖瓣環(huán)組織多普勒頻譜圖（TDI）：測量收縮期峰值速度（s′，cm/s）；舒張期早期峰值速度（e′，cm/s）；舒張期晚期峰值速度（a′，cm/s）；并計算e′/a′和E/e′。 以上測量均由同一檢查者操作，為盡量減少心率波動的影響，每一測量參數(shù)均以連續(xù)測量三個心動周期取測平均值。 統(tǒng)計分析 所有數(shù)據(jù)應(yīng)用SPSS13.0統(tǒng)計學(xué)軟件分析，計量資料以平均數(shù)±標(biāo)準(zhǔn)差表示，計數(shù)資料以百分率表示，先對各組樣本進行正態(tài)性檢驗，經(jīng)檢驗上述樣本均滿足正態(tài)性，再對臍帶繞頸組、單臍動脈組與正常對照組間指標(biāo)比較采用方差分析，同時各組由于病例數(shù)較少還需進行方差齊性檢驗，正態(tài)性檢驗及方差齊性檢驗的檢驗水準(zhǔn)一般較保守，常取0.10或0.20。方差分析按a=0.05的水準(zhǔn)，以P0.05時差異有統(tǒng)計學(xué)意義。 結(jié)果： 共對59例孕婦進行了64次胎兒超聲心動圖檢查，其中有5例孕婦進行了2次檢查。 1各組間一般資料比較 三組間孕婦年齡、心率及臍動脈S/D比值相比較差異無統(tǒng)計學(xué)意義（P＞0.05)。 2右心室整體功能p-tei指數(shù)比較 A組高于正常對照組，差異具有統(tǒng)計學(xué)意義（P＜0.05)；A組高于B組，差異具有統(tǒng)計學(xué)意義（P＜0.05)；B組與正常對照組比較，差異無統(tǒng)計學(xué)意義（P＞0.05)； 3右心室功能各參數(shù)比較 3.1右心室收縮功能各參數(shù)結(jié)果 三組間TAPSE值差異無統(tǒng)計學(xué)意義（P＞0.05)；三組間s′值差異無統(tǒng)計學(xué)意義（P＞0.05)； 3.2右心室舒張功能各參數(shù)結(jié)果 三組間的E/A、e′/a′、E/e′比值差異均無統(tǒng)計學(xué)意義（P＞0.05)； 4各參數(shù)與孕周的關(guān)系 胎兒右心室E/A、e′/a′、TAPSE、s′值隨孕周增大而增大，E/e′、Tei指數(shù)及胎心率（FHR）隨孕周增大而減小，差異有統(tǒng)計學(xué)意義（P＜0.05)； 結(jié)論： 1臍帶繞頸胎兒p-tei指數(shù)要高于無臍帶繞頸的正常胎兒，，因此，通過測量p-tei指數(shù)可以監(jiān)測臍帶繞頸胎兒心室收縮功能和舒張功能，進而通過p-tei指數(shù)的變化可以發(fā)現(xiàn)臍帶繞頸時胎兒心功能異常的改變，提示臍帶繞頸胎兒右室整體功能比正常對照組略減低； 2單臍動脈組與正常對照組的右室收縮功能與舒張功能無明顯差異；故單臍動脈胎兒如不合并心內(nèi)外畸形，與正常胎兒無異。 3胎兒右心室E/A、e′/a′、TAPSE、s′隨孕周增大而增大，E/e′、Tei指數(shù)及胎心率（FHR）隨孕周增大而減小。
[Abstract]:Objective:
The use of Doppler tissue imaging (Tissue Doppler, Imaging, TDI) and Tei index in the evaluation of fetal umbilical cord around the neck (umbilieal cord around neck, UCAN) and simple single umbilical artery (simple single umbilical artery SUA) of the right ventricular systolic and diastolic function, provide the basis for the umbilical cord around the neck and prenatal counseling of simple single umbilical fetal arterial and clinical treatment.
Method:
Subjects: 59 pregnant women were selected from 23-40 weeks of gestational age (average gestational age of 28.4 + 3.9 weeks). The age of pregnant women was 21-35 years (average age 27.3 + 4 years). It was divided into three groups.
The fetal ultrasound system confirm the umbilical cord around the neck but no fetal distress, umbilical cord around the neck group (A group), a total of 16 cases. The average gestational age was 28.4 + 3.4 weeks pregnant women, aged 21-30 years, mean age 26.6 + 4 years old; the fetal system ultrasonography confirmed as simple as single umbilical artery, vein group dynamic single umbilical (B group), a total of 15 cases. The average gestational age was 28.8 + 3.3 weeks pregnant women, aged 22-33 years, mean age 26.9 + 4.1 years; by fetal system ultrasonography and fetal echocardiography confirmed without congenital malformations and intrauterine growth retardation, normal control group, a total of 28 cases. The average pregnancy at the age of 28.2 + 3.8 weeks pregnant women, aged 21-35 years, mean age 27.8 + 4 years; inclusion criteria: the first is to have fetal conditions: early fetal system ultrasonography confirmed, gestational age and gestational age; and after fetal system ultrasonography and fetal echocardiography screening without congenital malformations and intrauterine growth retardation The second is: the condition of pregnant women; history and past medical and health records of the pregnant women check and examination results, confirm the health of pregnant women, no smoking, alcohol abuse, hypertension, diabetes, heart, liver, kidney and other chronic diseases, no family history and family history of congenital heart disease. Without taking indomethacin and other non steroidal nonsteroidal anti - inflammatory drug history.
Use instrument: use GE VIVID E9 color Doppler ultrasonic diagnostic instrument, use 6S probe, probe frequency 2.5-6MHz, this instrument has TDI program.
Image storage: quiet breathing conditions, will all pregnant women in the supine or side comfort conditions, choose do not frequent movement when in the two-dimensional models obtain the standard and clear fetal four chamber view, first in the two-dimensional mode, play clear four chamber, the sample volume placed three tricuspid valve mouth right ventricular side,
Start the PW button, get 5 or more consecutive fetal cardiac cycle three diastolic tricuspid orifice flow chart, storage; secondly in two-dimensional mode, start the M type ultrasonic function keys, the sampling lines placed in three tricuspid annulus and right ventricular free wall junction, three tricuspid annular displacement diagram of continuous scanning 5 the fetal cardiac cycle stable (Tricuspid annular plane systolic excursion TAPSE), storage until after the analysis. Start TDI function key, switch to the pulse Doppler (PW), the sampling lines placed in three tricuspid annulus and right ventricular free wall junction, try to make the sound beam and myocardial longitudinal parallel, three tip valve ring Doppler spectrum continuous scanning more than 5 fetal cardiac cycle stability, storage for later analysis. Finally, in the two-dimensional mode, with long axis view of pulmonary artery clearly, the sampling lines placed in the pulmonary valve, start the PW key, get 5 consecutive The systolic blood flow spectrum of the pulmonary artery in the systolic phase of the fetal heart cycle above.
Graphic analysis and parameter measurement:
1 three cusp mouth blood flow spectrum (PW): measure three cusp mouth diastolic early peak speed (E, cm/s); late diastolic peak velocity (A, cm/s); and calculate E/A., the A peak of the previous period ends to the next period E peak start time interval is (a, MS).
2 pulmonary blood flow spectrum (PW): the systolic pulmonary valve peak flow of time (ejection time ejection time, ET) (B, MS) is A-B; for the isovolumic contraction time (isovolumetriccontraction, time, ICT) and isovolumic relaxation time (isovolumetric relaxationtime, IRT) and.
The 3 right ventricular p-tei index = (ICT+IRT) /ET, that is, the p-tei index of the right ventricle = (a-b) /b.
4 the three Doppler annulus tissue TDI spectrum (s): the systolic peak velocity (s', cm/s), the diastolic peak velocity (E ', cm/s), the late diastolic peak velocity (a', cm/s), and E '/a' and E/e 'were calculated.
The above measurements were performed by the same examiner to minimize the impact of heart rate fluctuations. Each measurement parameter was measured by three consecutive cardiac cycles.
statistical analysis
All data were analysed using SPSS13.0 statistical software, measurement data with the average standard deviation, count data expressed as a percentage, the first test of normality for each sample, the samples were tested to meet the normality of the umbilical cord around neck group, single umbilical artery group and normal control group were compared by variance the analysis, at the same time the groups because of fewer cases need for homogeneity of variance test, test of normality and homogeneity of variance test level is generally conservative, often take 0.10 or 0.20. variance analysis according to the a=0.05 standard, the difference was statistically significant P0.05.
Result錛

本文編號：1426707