組織多普勒成像Tei指數(shù)在臍帶繞頸胎兒心室功能評(píng)價(jià)中的應(yīng)用
發(fā)布時(shí)間:2018-07-14 21:25
【摘要】:臍帶是母胎間進(jìn)行血?dú)饨粨Q的橋梁,其供血情況直接影響胎兒的生長發(fā)育。臍帶繞頸是產(chǎn)科中一種常見的并發(fā)癥,且近年來有逐年增加的趨勢,胎兒宮內(nèi)缺氧的主要原因之一即為臍帶繞頸,而缺氧往往又會(huì)引起心功能的改變。本研究旨在利用組織多普勒成像Tei指數(shù)監(jiān)測臍帶繞頸胎兒心室功能的變化,為臨床評(píng)估胎兒宮內(nèi)狀態(tài)提供重要的信息,以達(dá)到預(yù)防不良妊娠結(jié)局發(fā)生的目的。 本研究選取孕齡為37~41+6周的住院孕婦173例,根據(jù)胎兒是否有臍帶繞頸分為繞頸組及對(duì)照組,繞頸組55例,均經(jīng)分娩證實(shí)。無繞頸者為對(duì)照組,共118例,成功獲得胎兒左、右心室Tei指數(shù)的為115例。使用GE Volusion E8彩色多普勒超聲診斷儀,囑孕婦取仰臥位或左側(cè)臥位,首先對(duì)胎兒進(jìn)行常規(guī)產(chǎn)科超聲檢查以估算胎兒孕周。然后判斷胎兒是否有臍帶繞頸,并確定臍帶繞頸的周數(shù)后,取胎兒標(biāo)準(zhǔn)四腔心切面,啟用組織多普勒成像(Tissue Doppler imaging, TDI)程序,將多普勒取樣容積分別置于二尖瓣后葉與二尖瓣環(huán)連接處及三尖瓣前葉與三尖瓣環(huán)連接處,獲得胎兒心臟二、三尖瓣環(huán)組織多普勒頻譜。 按公式Tei指數(shù)=(ICT+I(xiàn)RT)/ET進(jìn)行計(jì)算,其中ICT為等容收縮時(shí)間,IRT為等容舒張時(shí)間,ET為射血時(shí)間,所有測量結(jié)果均為三個(gè)連續(xù)心動(dòng)周期的平均值,并隨訪所有胎兒出生后1分鐘Apgar評(píng)分。 應(yīng)用SPSS17.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x s)表示,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),檢驗(yàn)水準(zhǔn)取α=0.05,P<0.05為差異有統(tǒng)計(jì)學(xué)意義,兩個(gè)變量之間的關(guān)系采用Pearson相關(guān)分析。 記錄數(shù)據(jù),相關(guān)結(jié)果如下: 1正常胎兒左、右心室Tei指數(shù)測量成功率。 118例正常對(duì)照組胎兒檢查過程中,3例胎兒因受孕婦肥胖、胎兒胎齡相對(duì)較大及胎位枕橫位等的影響,未獲得較滿意的組織多普勒頻譜圖像,,放棄對(duì)其ICT、IRT及ET的測量,余115例胎兒所得二、三尖瓣環(huán)組織多普勒頻譜清晰易于ICT、IRT、ET的測量及Tei指數(shù)的計(jì)算。本研究正常對(duì)照組胎兒左、右心室Tei指數(shù)測量成功率為97.5%。 2正常胎兒左、右心室ICT+I(xiàn)RT、ET及Tei指數(shù)與孕周無相關(guān)性(左心室相關(guān)系數(shù)r值分別為-0.099、0.051、0.062,P值分別為0.292、0.589、0.510;右心室相關(guān)系數(shù)r值分別為0.066、0.057、-0.030,P值分別為0.485、0.548、0.751)。 3正常胎兒左、右心室ICT+I(xiàn)RT及ET與胎心率呈負(fù)相關(guān),Tei指數(shù)與胎心率無相關(guān)性(左心室相關(guān)系數(shù)r值分別為-0.531、-0.482、-0.019,P值分別為0.000、0.000、0.844;右心室相關(guān)系數(shù)r值分別為-0.447、-0.410、0.124,P值分別為0.000、0.000、0.186)。 4胎兒左心與右心ICT+I(xiàn)RT、ET及Tei指數(shù)差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。 5臍帶繞頸組胎兒左、右心室Tei指數(shù)及ICT+I(xiàn)RT均高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),ET值低于對(duì)照組,但無統(tǒng)計(jì)學(xué)意義(P>0.05)。 6繞頸組胎兒出生后窒息率明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。 7臍帶繞頸胎兒左、右心室Tei指數(shù)與新生兒1分鐘Apgar評(píng)分呈負(fù)相關(guān)(左心室r=-0.727,P=0.00;右心室r=-0.640,P=0.00)。 綜上所述,正常胎兒左、右心室Tei指數(shù)測量簡便,可重復(fù)性強(qiáng),有較高的獲取率,為97.4%。正常胎兒左、右心室Tei指數(shù)不受孕周及心率的影響,有較好的穩(wěn)定性。臍帶繞頸組胎兒左、右心室Tei指數(shù)高于正常對(duì)照組,繞頸組胎兒出生后窒息率高于對(duì)照組,臍帶繞頸胎兒左、右心室Tei指數(shù)與新生兒1分鐘Apgar評(píng)分呈負(fù)相關(guān)。Tei指數(shù)可用于臍帶繞頸胎兒心室功能改變的評(píng)價(jià),對(duì)判斷胎兒宮內(nèi)是否乏氧及評(píng)估胎兒預(yù)后也有一定的臨床應(yīng)用價(jià)值。
[Abstract]:Umbilical cord is a kind of bridge with blood gas exchange between mother and fetus . The umbilical cord around the neck is a common complication in the birth and development of the fetus . One of the main causes of fetal intrauterine hypoxia is umbilical cord around the neck , and hypoxia often causes changes in cardiac function . This study is aimed to monitor the fetal ventricular function changes of umbilical cord around the neck with tissue Doppler imaging Tei index to provide important information for the clinical evaluation of fetal intrauterine state to achieve the purpose of preventing adverse pregnancy outcome .
In this study , 173 cases of pregnant women with gestational age of 37 锝
本文編號(hào):2122999
[Abstract]:Umbilical cord is a kind of bridge with blood gas exchange between mother and fetus . The umbilical cord around the neck is a common complication in the birth and development of the fetus . One of the main causes of fetal intrauterine hypoxia is umbilical cord around the neck , and hypoxia often causes changes in cardiac function . This study is aimed to monitor the fetal ventricular function changes of umbilical cord around the neck with tissue Doppler imaging Tei index to provide important information for the clinical evaluation of fetal intrauterine state to achieve the purpose of preventing adverse pregnancy outcome .
In this study , 173 cases of pregnant women with gestational age of 37 锝
本文編號(hào):2122999
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