产前超声检测肺静脉血流流速曲线在胎儿心脏结构异常中的诊断价值

发布时间：2018-07-04 22:31

本文选题：胎儿心脏 + 肺静脉　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：探讨正常中晚孕期单胎胎儿肺静脉血流流速曲线的变化规律及肺静脉血流流速曲线改变对胎儿心脏结构异常的诊断价值。材料与方法：收集2013年1月至2014年5月在我院进行中晚孕期产前超声筛查且正规产检的所有单胎胎儿，从中选取正常中晚孕期胎儿295例作为正常对照组，心脏结构异常胎儿95例作为异常组。采用Philips iE33彩色多普勒超声诊断仪分别对两组胎儿行常规产科超声检查和心脏超声检查，测量胎儿肺静脉血流流速曲线参数（S、D、A、Vmean、VTI），并根据S、D、A、Vmean计算S/D、PI、PVI，观察并记录超声检查表现。分析正常对照组胎儿左、右肺静脉血流流速曲线形态特点，肺静脉血流流速曲线参数与孕周的相关性，并比较左、右肺静脉血流流速曲线参数间差异有无统计学意义。分析心脏结构异常组胎儿肺静脉血流流速曲线形态改变规律及与心脏结构异常的关系。结果：295例正常对照组胎儿左右肺静脉血流流速曲线形态相似呈三相波，均包含S、D、A波。S/D1者：左肺静脉250例（占84.7%），右肺静脉251例（占85.1%）；S/D 1者：左肺静脉36例（占12.2%），右肺静脉36例（占12.2%）；S/D=1者：左肺静脉9例（占3.1%），右肺静脉8例（占2.7%）。胎儿肺静脉血流流速曲线A波在多数胎儿表现为正向波，少数缺失，未发现反向波，其中A波正向者左肺静脉284例（占96.3%），右肺静脉282例（占95.6%），A波缺失者左肺静脉11例（占3.7%），右肺静脉13例（占4.4%）。胎儿左、右肺静脉血流流速曲线参数S、D、A、Vmean、VTI与孕周呈正相关，S/D、PI、PVI与孕周无明显相关关系。心脏结构异常组95例胎儿中12例肺静脉血流流速曲线A波缺失，包括7例左心梗阻性疾病，3例右心梗阻性疾病，2例间隔缺损；10例A波反向，包括5例左心梗阻性疾病，1例右心梗阻性疾病，1例间隔缺损，3例圆锥动脉干畸形；4例肺静脉血流流速曲线形态异常呈连续波形改变，，不随左心房收缩而变化，4例均为完全性肺静脉异位引流胎儿。结论：胎儿肺静脉血流流速曲线形态异常、A波缺失或A波反向时，可提示存在胎儿心脏结构异常的可能，应进一步做胎儿心脏超声检查。肺静脉血流流速曲线形态改变，呈连续波形不随左心房的收缩而变化时，可提示胎儿存在肺静脉异位引流的可能。检测胎儿肺静脉血流流速曲线对辅助诊断胎儿心内结构异常有一定临床意义，建议可作为胎儿产前超声检查的观察指标。
[Abstract]:Objective: to investigate the changes of pulmonary venous flow velocity curve in single fetus and the diagnostic value of pulmonary vein flow velocity curve in fetal cardiac abnormalities. Materials and methods: from January 2013 to May 2014, all single foetus were screened by prenatal ultrasound in our hospital, and 295 normal fetuses were selected as normal control group. 95 fetuses with abnormal cardiac structure were used as abnormal group. Two groups of fetuses were examined by Philips iE33 color Doppler ultrasound instrument. The parameters of fetal pulmonary vein blood flow velocity curve were measured by routine obstetrical ultrasonography and echocardiography. To analyze the morphological characteristics of left and right pulmonary venous velocity curves and the correlation between the parameters of pulmonary vein flow velocity curve and gestational weeks in the normal control group, and to compare the difference between left and right pulmonary vein flow velocity curve parameters. Objective: to analyze the changes of fetal pulmonary venous flow velocity curve and its relationship with abnormal cardiac structure in patients with abnormal cardiac structure. Results the blood flow velocity curve of left and right pulmonary veins of 295 normal fetuses was similar to that of three-phase waves. All the three phase waves were found in the left pulmonary vein in 250 cases (84.7%) and the right pulmonary vein in 251 cases (85.1%). S / D 1: left pulmonary vein in 36 cases (12.2%), right pulmonary vein in 36 cases (12.2%), left pulmonary vein in 9 cases (3.1%), right pulmonary vein in 8 cases (2.7%). In most fetuses, A wave of flow velocity of fetal pulmonary vein showed positive wave, a few were missing, no reverse wave was found. There were 284 cases of left pulmonary vein (96.3%) with positive A wave, 282 cases (95.6%) of right pulmonary vein, 11 cases (3.7%) of left pulmonary vein with missing A wave, 13 cases (4.4%) of right pulmonary vein. The VTI parameters of left and right pulmonary veins were positively correlated with gestational weeks. Of 95 fetuses with abnormal cardiac structure, 12 cases were without A wave of pulmonary vein flow velocity curve, including 7 cases of left ventricular obstructive disease and 3 cases of right heart obstructive disease and 2 cases of septal defect in 10 cases of A wave reverse. Including 5 cases of left ventricular obstructive disease, 1 case of right heart obstructive disease, 1 case of septal defect, 3 cases of conical artery trunk malformation, 4 cases of anomalous pulmonary vein flow velocity curve showed continuous waveform changes. No change with left atrial contraction was found in all 4 cases with complete anomalous pulmonary venous drainage. Conclusion: the absence of A wave or the reverse of A wave in fetal pulmonary vein flow velocity curve may indicate the possibility of fetal heart structure abnormality, which should be further examined by fetal echocardiography. When the flow velocity curve of pulmonary vein changes in shape and the continuous waveform does not change with the contraction of left atrium, it may indicate the possibility of anomalous pulmonary venous drainage in fetus. Detecting the flow velocity curve of fetal pulmonary vein has a certain clinical significance in the diagnosis of fetal heart structure abnormality. It is suggested that it can be used as an observation index of fetal prenatal ultrasound examination.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.5

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