中晚期妊娠胎儿肺动脉射血加速时间测定及其临床意义

发布时间：2017-12-28 11:16

本文关键词：中晚期妊娠胎儿肺动脉射血加速时间测定及其临床意义　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：利用彩色多普勒超声对中晚期妊娠胎儿心脏肺动脉血流频谱中的相关参数,如：肺动脉加速时间(AT)、右心室排血时间(ET)、肺动脉加速时间比右心室排血时间(AT/ET)、肺动脉收缩压(PASP)等的测定,并对观察组的三尖瓣反流速度,三尖瓣反流压力阶差等与AT进行相关性分析,试图证明AT是诊断胎儿肺动脉压高低的敏感指标。方法：本研究使用美国产Philips -iu22及IE33彩色多普勒超声仪,研究对象：选取31例中晚期妊娠孕妇(除外先心病可能的检测到有不同程度三尖瓣反流的胎儿)作为观察组,随机选取68例妊娠中晚期孕妇(胎儿经严格筛查无三尖瓣反流、无先心病等疾患)作为对照组,获得两组的肺动脉收缩压(PASP)、右室排血时间(ET)、肺动脉血流加速时间(AT),AT/ET值。观察组检测三尖瓣反流速度(TRV)、三尖瓣反流压力阶差(PG),部分病例还检测了动脉导管(DU)、DU速度、右肺动脉血流加速时间(RPA-AT)等参数,绝大多数患儿出生后进行了1天～62天的随访。两组数据均采用SPSS17汉化数理统计包进行统计学处理。结果：观察组AT为47.6±5.0ms；对照组AT为54.3±9.8ms 两组P0.0001统计学相差非常显著。观察组AT与三尖瓣反流程度(TR)做相关分析,二者呈负相关(r=-0.426,P=0.0170.05)相差显著。AT/ET值与TR亦呈负相关关系,且相关关系密切(r=-4.79,P=0.006)。AT值与孕妇年龄,孕周无明显相关关系；TR与孕周、年龄也无相关性。肺动脉收缩压PASP与AT呈负相关(r=-0.53 P0.01)；PASP与AT/ET也呈负相关(r=-0.52 P0.01)。胎儿出生后经1-62天的随访结果显示绝大多数患儿三尖瓣反流明显好转或消失。结论：通过以上结果分析提示：中晚期妊娠胎儿肺动脉射血加速时间(AT)及其与右心室排血时间比(AT/ET)与三尖瓣反流程度、反流速度、反流压差及肺动脉收缩压均呈负相关；说明AT测值越小,提示肺动脉收缩压越高,三尖瓣反流程度也越严重。AT值可以作为一项新指标预测胎儿肺动脉压升高的程度,这一新指标尤其对没有三尖瓣反流但存在肺动脉压有增高的胎儿肺动脉压的检测更具有应用价值。
[Abstract]:Objective: the use of color Doppler ultrasound in pregnancy fetal heart and pulmonary arterial flow spectrum in the relevant parameters, such as: for advanced pulmonary artery acceleration time (AT), right ventricular ejection time (ET), pulmonary artery acceleration time than right ventricular ejection time (AT/ET), pulmonary artery systolic pressure (PASP) determination etc. and the observation group, three tricuspid regurgitation velocity, three tricuspid regurgitation gradient and correlation analysis with AT, trying to prove that AT is a sensitive index for the diagnosis of fetal pulmonary artery pressure. Methods: This study used the Philips -iu22 and IE33 color Doppler ultrasound, the research object: a total of 31 pregnant women (except to the detection of CHD may have different degrees of tricuspid regurgitation in three fetuses) as the observation group, randomly selected 68 cases of pregnant women in late pregnancy (fetal screening by strict three tips regurgitation, congenital heart disease and other diseases) as the control group, obtained two groups of pulmonary artery systolic pressure (PASP), right ventricular ejection time (ET), pulmonary artery acceleration time (AT), AT/ET value. In the observation group, three cusp regurgitation velocity (TRV) and three cusp regurgitation pressure gradient (PG) were detected. In some cases, arterial catheter (DU), DU velocity and right pulmonary artery blood flow acceleration time (RPA-AT) were detected in some cases. Most children were followed up for 1 days to 62 days after birth. The two groups of data were statistically processed by SPSS17 Sinicization mathematical statistics package. Results: the AT in the observation group was 47.6 + 5.0ms, and the AT in the control group was 54.3 + 9.8ms two groups, and the difference between the P0.0001 statistics was very significant. The correlation analysis was made between the observation group AT and the three apex regurgitation (TR), and the negative correlation (r=-0.426, P=0.0170.05) was significant in the two groups. The AT/ET value also has a negative correlation with TR, and the correlation is close (r=-4.79, P=0.006). There was no significant correlation between AT value and pregnant women's age and gestational age, and there was no correlation between TR and gestational age and age. The systolic pressure of pulmonary artery was negatively correlated with AT (r=-0.53 P0.01), and PASP was negatively correlated with AT/ET (r=-0.52 P0.01). After 1-62 days of follow-up, the results showed that most of the three apex regurgitation improved or disappeared in most of the children. Conclusion: through the analysis of the above results suggest: in late pregnancy fetal pulmonary ejection acceleration time (AT) and right ventricular ejection time ratio (AT/ET) and three tricuspid valve regurgitation, regurgitation velocity, reflux pressure and pulmonary artery systolic pressure were negatively correlated with AT values smaller; prompt, pulmonary artery systolic pressure is higher, the more severe tricuspid valve regurgitation is three. The AT value can be used as a new index to predict the degree of fetal pulmonary hypertension. This new index is especially valuable for the detection of fetal pulmonary artery pressure without the presence of three cusp regurgitation but with increased pulmonary artery pressure.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R714.5;R445.1

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