PW-TDI及Mod-MPI在评估妊娠高血压子痫前期胎儿左心功能中的应用

发布时间：2018-01-06 06:20

本文关键词：PW-TDI及Mod-MPI在评估妊娠高血压子痫前期胎儿左心功能中的应用　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨应用脉冲组织多普勒及改良心肌活动指数联合评价不同程度子痫前期胎儿的左心功能。方法:选择2015年10月至2016年06月在赤峰学院附属医院超声科进行检查的孕中、晚期妊娠高血压子痫前期孕妇32例作为实验组,根据子痫前期孕妇的收缩压、舒张压、尿蛋白及症状等将实验组分为两组:轻度子痫前期组(MPE)13例、重度子痫前期组(SPE)19例;另选同期在我院超声科进行检查的正常中晚期妊娠孕妇50例作为对照组(CG),应用超声脉冲组织多普勒测定胎儿左心功能指标:即二尖瓣后叶瓣环处心肌舒张早期运动峰值Ea、舒张晚期运动峰值Aa、收缩期运动峰值S,二尖瓣瓣口血流舒张早期峰值E、舒张晚期峰值A,以及Mod-MPI相关指标:左心室射血期时间(ET)、等容舒张期时间(IVRT)及等容收缩期时间(IVCT)。然后对E、A、Ea、Aa、S、E/A、Ea/Aa、E/Ea及改良心肌活动指数Mod-MPI即[(IVCT+IVRT)/ET]进行测定、计算,并对对照组、轻度子痫前期组、重度子痫前期组的相关参数通过单因素方差分析及t检验等方法进行相关结果的统计学分析。结果:1、各组一般资料的比较实验组孕龄、脐动脉血流S/D值均高于对照组,差异无统计学意义(P0.05)。2、实验组E、A以及Aa值均低于对照组,差异无统计学意义(P0.05);重度子痫前期组Ea、Ea/Aa低于对照组、E/Ea高于对照组,差异有统计学意义(P0.05);轻度子痫前期组E/Ea较对照组高,Ea、Ea/Aa较对照组低,差异无统计学意义(P0.05);重度子痫前期组Ea/Aa、Ea值低于轻度子痫前期组、E/Ea高于轻度子痫前期组,差异无统计学意义(P0.05)。3、实验组S值、ET值低于对照组,差异无统计学意义(P0.05)。4、重度子痫前期组(IVCT+IVRT)及Mod-MPI高于对照组,差异有统计学意义(P0.05);轻度子痫前期组(IVCT+IVRT)及Mod-MPI较对照组高,差异无统计学意义(P0.05)。结论:1.多项实验数据统计显示,胎儿左心舒张功能、收缩功能及整体功能在不同程度妊娠期高血压子痫前期时均已受到一定程度的损害,且其受损程度在对照组、MPE组、SPE组中呈现出逐渐上升的趋势。这印证了孕妇的血压高低可影响胎儿左心功能,血压越高胎儿的左心功能受损越显著。2.在反映胎儿左室的舒张功能时,多普勒组织成像(TDI)技术测得的二尖瓣瓣环处的心肌运动峰值速度较二尖瓣瓣口舒张期血流运动峰值速度更敏感、真实。在实际工作中由于各种超声检查方法都存在一定的局限性,加之胎儿心脏本身的特殊性,为了更加准确地评价胎儿左心功能就必须采取多种方法综合评判。
[Abstract]:Objective: to evaluate the left ventricular function of fetuses with different degrees of preeclampsia by pulse tissue Doppler and modified myocardial activity index. Select pregnant women who were examined in the Department of Ultrasound from October 2015 to June 2016 in the affiliated Hospital of Chifeng College. Thirty-two pregnant women with pre-eclampsia were used as experimental group according to systolic blood pressure and diastolic blood pressure of pre-eclampsia pregnant women. Urine protein and symptoms were divided into two groups: mild preeclampsia group (n = 13) and severe preeclampsia group (n = 19). In addition, 50 normal pregnant women with intermediate and late pregnancy who were examined by ultrasound department in our hospital at the same time were selected as the control group (CGG). The indexes of fetal left ventricular function were measured by ultrasonic pulse tissue Doppler: early diastolic peak (EA), late diastolic movement peak (Aa) and systolic motion peak (S) at the posterior lobe annulus of mitral valve. Mitral orifice early diastolic peak E, late diastolic peak A, and Mod-MPI related indexes: left ventricular ejection time (et). Isovolumic diastolic time (IVRTT) and isovolumic contraction time (IVCTT). E / EA and modified myocardial activity index (Mod-MPI). [IVRT)/ET was measured, calculated, and compared with control group, mild preeclampsia group. The related parameters of severe preeclampsia group were statistically analyzed by single factor analysis of variance and t test. Results: 1. The gestational age of the experimental group was compared with the general data of each group. The S / D value of umbilical artery blood flow was higher than that of the control group, there was no significant difference between the two groups (P 0.05). The values of EMA and AA in the experimental group were lower than those in the control group (P 0.05). In severe preeclampsia group, EA / A was significantly lower than that in control group (P 0.05). The E- / EA of mild preeclampsia group was lower than that of the control group (P < 0.05). In severe preeclampsia group, EA / AaFEA value was lower than that in mild preeclampsia group, which was higher than that in mild preeclampsia group, there was no significant difference (P0.05. 3), the S value of experimental group was higher than that of mild preeclampsia group. The level of et was lower than that of the control group (P 0.05) and Mod-MPI was higher than that of the control group (P 0.05). The difference was statistically significant (P 0.05). Mod-MPI and IVCT in mild preeclampsia group were higher than those in control group (P 0.05). The left ventricular diastolic function, systolic function and global function were all damaged in different degree of hypertensive preeclampsia in pregnancy, and the degree of damage was in MPE group. In SPE group, there was an increasing trend, which confirmed that maternal blood pressure can affect fetal left heart function, the higher the fetal blood pressure, the more significant left heart function damage. 2. In reflecting the left ventricular diastolic function of fetus. The peak velocity of myocardial movement at mitral annulus measured by Doppler tissue imaging TDI technique was more sensitive than that at mitral valve orifice diastolic phase. In the actual work, due to the limitations of various ultrasound examination methods, coupled with the particularity of the fetal heart itself. In order to evaluate fetal left ventricular function more accurately, a variety of methods must be adopted.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.246;R445.1

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