本文選題：三維容積超聲　切入點(diǎn)：胎兒顱腦　出處：《中南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：先天性心臟病是最常見(jiàn)的胎兒畸形,而神經(jīng)系統(tǒng)發(fā)育以及功能異常普遍存在于先心病患兒中。已有研究證實(shí)不僅手術(shù)中及術(shù)后的許多因素對(duì)先心病兒童的神經(jīng)系統(tǒng)產(chǎn)生損害,先心病患兒在手術(shù)前甚至在宮內(nèi)已經(jīng)存在大腦的發(fā)育異常或腦損傷。因此,對(duì)先心病胎兒進(jìn)行大腦發(fā)育的評(píng)價(jià)具有重要意義及臨床價(jià)值。 研究目的：應(yīng)用三維超聲測(cè)量不同孕周胎兒額葉及丘腦容積,建立正常胎兒額葉及丘腦容積的生長(zhǎng)曲線。探討先心病胎兒與正常胎兒額葉及丘腦容積之間可能存在的差異,及腦血流與腦容積變化的相關(guān)性。 對(duì)象及方法：隨機(jī)選取2013-2014年于本院超聲科進(jìn)行產(chǎn)科超聲檢查的孕婦246例,其中正常胎兒172例,產(chǎn)前診斷為先心病胎兒74例。應(yīng)用三維超聲成像技術(shù)及VOCAL容積分析程序測(cè)量胎兒額葉及丘腦三維容積,并獲得大腦中動(dòng)脈及臍動(dòng)脈的血流動(dòng)力學(xué)參數(shù)PI及CPR。評(píng)價(jià)正常胎兒額葉及丘腦三維容積與孕周及顱腦二維生長(zhǎng)參數(shù)(BPD/HC)的相關(guān)性,并建立額葉及丘腦容積隨孕周增長(zhǎng)的回歸模型。比較正常組與先心病組胎兒額葉及丘腦容積差異,并探討腦血流與腦容積變化的相關(guān)性。 結(jié)果：成功獲取242例胎兒顱腦三維容積,其中正常胎兒168(168/172)例,平均孕齡28.20±4.44,先心病胎兒73(73/74)例,平均孕齡28.15±4.04周。1.正常胎兒額葉及丘腦容積與孕周、雙頂徑及頭圍密切相關(guān)(P0.0001),額葉及丘腦容積隨孕周呈S曲線增長(zhǎng),回歸方程：額葉容積=e(7.393-100.037*孕周’(R2=0.965,P0.0001),丘腦容積=e(4.823-111.718*孕周)(R2=0.983,P0.0001)。2.在孕晚期(≥30周),先心病組胎兒(23/73例)額葉及丘腦容積較正常組胎兒(63/168例)減小(P0.001,P0.05),額葉容積差異在經(jīng)頭圍標(biāo)準(zhǔn)化后仍然顯著(P0.001)。3.先心病胎兒組MCA-PI及CPR較正常胎兒組降低(P0.05, P0.001), CPR的減小與額葉及丘腦容積的減小關(guān)系密切(R=0.618,0.634,P0.001)。 結(jié)論：三維超聲可用于測(cè)量胎兒顱內(nèi)結(jié)構(gòu)容積,具有操作性及可重復(fù)性。先心病在宮內(nèi)即影響胎兒大腦發(fā)育,導(dǎo)致晚孕期胎兒額葉及丘腦容積相對(duì)減小,其原因可能與先心病胎兒腦血流動(dòng)力學(xué)的改變相關(guān)。
[Abstract]:Background: congenital heart disease is the most common fetal malformation. However, abnormal development and function of nervous system are common in children with congenital heart disease. It has been proved that many factors, not only during surgery but also after operation, can damage the nervous system of children with congenital heart disease. The abnormal development of brain or brain injury exists in children with congenital heart disease before operation and even in the uterus. Therefore, it is of great significance and clinical value to evaluate the development of brain in infants with congenital heart disease. Objective: to measure the frontal lobe and thalamus volume of fetuses of different gestational weeks and to establish the growth curve of normal fetal frontal lobe and thalamus by three-dimensional ultrasound, and to explore the possible difference between fetal frontal lobe and thalamus volume of congenital heart disease and normal fetus. And the correlation between cerebral blood flow and cerebral volume. Participants and methods: a total of 246 pregnant women, including 172 normal fetuses, were randomly selected for obstetric ultrasound examination in our hospital from 2013 to 2014. Three-dimensional ultrasound imaging and VOCAL volumetric analysis program were used to measure the three-dimensional volume of frontal lobe and thalamus in 74 cases of congenital heart disease diagnosed by prenatal diagnosis. The hemodynamic parameters Pi and CPRof middle cerebral artery and umbilical artery were obtained to evaluate the correlation between the three-dimensional volume of frontal lobe and thalamus of normal fetus and the two-dimensional growth parameters (BPD / HCC) of gestational and craniocerebral. A regression model of frontal lobe and thalamus volume with gestational weeks was established to compare the difference of fetal frontal lobe and thalamus volume between normal group and congenital heart disease group, and to explore the correlation between cerebral blood flow and cerebral volume. Results: a total of 242 cases of fetal brain volume were successfully obtained, of which 168 cases were normal fetuses, 168 cases were normal fetuses, the average gestational age was 28.20 鹵4.44, the mean gestational age of congenital heart disease fetus was 73% 73 / 74, the mean gestational age was 28.15 鹵4.04 weeks .1.The normal fetal frontal lobe and thalamus volume and gestational week. The bilateral parietal diameter and head circumference were closely related to P0.0001, and the volume of frontal lobe and thalamus increased with gestational weeks. The regression equation is: frontal lobe volume is 7.393-100.037 * gestational volume is 0.965U P0.0001, thalamus volume is 4.823-111.718* gestational age is 4.823-111.718. the difference of frontal lobe volume and thalamus volume is reduced in the third trimester of pregnancy (鈮，

本文編號(hào)：1647025