超声观察正常中晚孕期胎儿心排血量及其分布的变化情况

发布时间：2018-01-11 20:23

本文关键词：超声观察正常中晚孕期胎儿心排血量及其分布的变化情况　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声观察正常中晚期妊娠胎儿左、右心室排血量及通过卵圆孔、动脉导管、主动脉峡部的血流量随孕周进展的变化趋势以及在心脏及其大血管各部位分布的一般规律,同时得出中晚期不同孕周胎儿心输出量的正常参考值范围,为临床了解胎儿循环系统的生理情况及尽早鉴别胎儿异常病理情况提供指导。方法:对118例孕20~40周的正常孕妇开展常规胎儿超声以及胎儿心动图检查。根据胎儿孕周将这些孕妇分为5组,分别为1组:20~24周(n=23),2组:24+1~28周(n=24),3组:28+1~32周(n=24),4组:32+1~36周(n=25),5组:36+1~40周(n=22)。嘱孕妇取平卧位(不适时可取侧卧位),首先进行常规胎儿超声检查,了解胎儿的基本情况,如器官结构、胎盘、羊水等,目的是除外胎儿心外结构异常;在产科条件下测量胎儿双顶径、头围、腹围、股骨长,记录系统自动生成的胎儿孕周及体质量;然后在胎儿心脏条件下进行心脏相关参数的测量,方法为分别在左室流出道切面、右室流出道切面或三血管切面、动脉导管弓长轴切面、主动脉弓纵切面对主动脉、肺动脉、动脉导管以及主动脉峡部各部位进行内径的测量,此外,在四腔心切面的房间隔中部测量FO(Foramen ovale,卵圆孔)的直径,并且在各切面取得这些部位的血流频谱,采用手动包络模式得到它们的VTI(Velocity time integral,速度时间积分)和HR(Heart rate,心率)。最后应用公式Q(Quantity of flow,血流量)=(D(Diameter,内径)/2)2×3.14×VTI×HR计算出各个胎儿的左心室排血量、右心室排血量、联合心输出量、动脉导管流量、主动脉峡部流量及通过卵圆孔的血流量。结果:正常的中晚孕期胎儿左心室及右心室排血量、联合心输出量、主动脉峡部流量、动脉导管流量、卵圆孔流量随着孕周的增加呈幂函数曲线形增长;各组右心室排血量均大于左心室排血量,右心室排血量/左心室排血量随孕周增长而逐渐增加;各组动脉导管流量均大于主动脉峡部流量,主动脉峡部流量/动脉导管流量随孕龄增大而逐渐减小;主动脉峡部流量/联合心输出量随孕周的增大而逐渐减小;动脉导管流量/联合心输出量随孕周的进展而不断增大;右心室排血量/联合心输出量随孕周的进展而不断增大;左心室排血量/联合心输出量随孕周的增大而不断减小;卵圆孔血流量/联合心输出量从1组到3组随孕周的增加不断降低,自4组、5组变化不明显;主动脉峡部流量随胎儿体重的增长而逐渐增加;联合心输出量指数(即为联合心输出量/胎儿体质量)不随孕周的变化而发生改变。结论:本研究通过综合分析,得出了各个孕周正常中晚孕期胎儿左、右心室排出量、动脉导管流量、卵圆孔流量、主动脉峡部流量的正常参考值范围,并分析其随孕周进展在心脏及其大血管各部位分布变化的一般规律,有助于了解胎儿循环系统的生理情况,并且提高了预测以及鉴别胎儿异常情况发生的可能性,为判断胎儿在宫内发育的具体情况提供了可靠的依据。
[Abstract]:Objective: To investigate the ultrasound observation of normal fetal left and right ventricular cardiac output and arterial catheter through the foramen ovale, the change trend of blood flow in the aortic isthmus with gestational age and general progress of distribution in different parts of the heart and great vessels, the normal reference at the same time that in late stage of fetal cardiac output value the scope, provide guidance for the clinical understanding of physiological condition of the circulatory system of the fetus and early identification of abnormal fetal pathology. Methods: 118 cases of normal pregnant women at 20~40 weeks to carry out routine fetal ultrasound and fetal echocardiography. According to the fetal gestational age of these pregnant women were divided into 5 groups, respectively, into 1 groups: 20~24 weeks (n=23) 2 weeks, group 24+1~28 (n=24), the 3 group: 28+1~32 weeks (n=24), the 4 group: 32+1~36 weeks (n=25), the 5 group: 36+1~40 weeks (n=22). Pregnant women have supine position (not timely, desirable lateral position) the first routine ultrasonography of fetal The basic situation of children, such as organ structure, placenta, amniotic fluid, fetal heart to except structural abnormalities; fetal biparietal diameter measurement in obstetric conditions, head circumference, abdominal circumference, femur length, automatic recording system of fetal gestational age and body weight measurement; then heart related parameters in fetal heart conditions. The method is in the left ventricular outflow tract views respectively, right ventricular outflow tract or three vessel view, arterial arch long axis view of aortic arch with longitudinal aorta, pulmonary artery, measurement, and various parts of inner diameter of artery catheter aortic isthmus in addition, in the four chamber view of the atrial septum (Foramen ovale, FO Central measurement the diameter of foramen ovale), and blood flow spectrum of these parts in each section of the manual mode envelope their VTI (Velocity time integral HR, velocity time integral (Heart) and rate, heart rate). The final application The formula Q (Quantity of flow, blood flow (D) = (Diameter diameter) /2) 2 * 3.14 * VTI * HR to calculate each fetal left ventricular output, right ventricular output, combined cardiac output, arterial flow, aortic isthmus flow and blood flow through the foramen ovale results. Normal late pregnancy fetal left ventricular and right ventricular output, combined cardiac output, aortic isthmus flow, arterial flow, flow of the foramen ovale as the gestational weeks increased in a power function curve of each growth; right ventricular output is greater than the left ventricular output, right ventricular output / left ventricular cardiac output and increased gradually with gestation; each arterial flow was larger than the aortic isthmus flow, aortic isthmus flow / arterial duct flow with gestational age decreases; aortic isthmus flow / combined cardiac output with the gestational weeks increased gradually; artery catheter The flow / progress of combined cardiac output with gestational weeks increasing; right ventricular output / progress combined with cardiac output with gestational weeks increasing; left ventricular output / combined cardiac output with gestational weeks increasing and decreasing blood flow; the foramen ovale / combined cardiac output from the 1 group to the 3 group with gestational weeks increasing reduced, since the 4 group, 5 group did not change significantly; aortic isthmus flow with fetal weight increasing; combined cardiac output index (which is combined with cardiac output / fetal body weight) did not change with gestational weeks and change. Conclusion: This study through comprehensive analysis, obtained the gestational weeks of normal fetus in late pregnancy of left, right ventricular output, arterial traffic flow, foramen ovale, the normal reference value range of the aortic isthmus flow, and the analysis of its general rules with the gestational weeks of heart and great progress in various parts of the distribution of vascular changes, It helps to understand the physiological condition of fetal circulation system, and improves the possibility of prediction and identification of fetal abnormalities. It provides a reliable basis for judging the specific condition of fetus in intrauterine growth.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.5;R445.1

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