正常中、晚孕期胎儿右心室功能的超声定量研究
发布时间：2019-06-15 19:48
【摘要】：目的:应用组织多普勒速度显像(tissue velocity imaging,TVI)测定正常中晚孕胎儿三尖瓣环运动频谱,即收缩期及舒张早、晚期峰值速度,与右心室常用测量指标进行相关性研究,分析其评价右心室收缩及舒张功能的可行性,以及其随孕周的变化规律。应用解剖M型超声心动图(free angle M-mode,FAM)测量中晚孕正常不同孕周的胎儿三尖瓣环收缩期位移(fetal-tricuspid annular plane systolic excursion,f-TAPSE),分析其作为评估右心室收缩及舒张功能指标的应用价值以及随孕周的变化规律,并建立正常胎儿中孕组、晚孕组f-TAPSE的测量值参考范围。方法:选取135例常规胎儿超声检查未发现心脏及其他器官畸形,孕妇除外糖尿病、高血压等妊娠并发症,并且产妇有准确的停经史,或与超声检查估算的孕周相符合的胎儿,根据不同孕周分为4组:20-24+6d周,25-29+6d周,30-34+6d周,35-40周。应用TVI测量胎儿三尖瓣环收缩期峰值速度(myocardial tissue systolic velocity,Sa)以及舒张早期峰值速度(myocardial tissue early diastolic velocity,Ea)、舒张晚期峰值速度(myocardial tissue late diastolic velocity,Aa),将Ea、Aa、Sa与右心室功能常用测量指标:三尖瓣口舒张早期峰值流速(peak ventricular velocity,E)、舒张晚期峰值流速(peak atrial velocity,A)、肺动脉峰值血流速度(peak systolic velocity,PSV)、右心室每搏输出量(right ventricular stroke volume,RV-SV)以及右心室射血分数(right ventricular ejection fraction,RVEF)进行相关性分析;并应用M型超声于三尖瓣环水平测量f-TAPSE,分析其随孕周的变化规律,以及其与右心室功能常用测量指标的相关性。不同孕周(gestational age,GA)组间f-TAPSE及右室功能常用测量指标的比较采用单因素方差分析,各因素间的相关性分析采用Pearson相关分析。结果:1.正常中晚孕胎儿常规右心室测量指标E、A、PSV、RV-SV均随着孕周增长而增加,且E/A比值随孕周逐渐增加趋近于1,但RVEF随孕周变化不明显。2.正常中晚孕胎儿不同孕周组间Ea、Aa、Ea/Aa、Sa组间比较差异均具有统计学意义(P=0.000),均随着孕周的增长而升高,整个孕期内Ea/Aa比值由0.41±0.08(20孕周)增加到0.73±0.03(40孕周),且Ea/Aa始终1,这与三尖瓣口血流速度测值E/A比值变化相一致,二者具有明显相关性。并且多普勒测值Ea、Aa与右心室舒张功能指标E、A具有良好的相关性,Sa与右心室收缩功能指标PSV、RV-SV具有良好相关性。3.正常中晚孕胎儿不同孕周组间f-TAPSE组间比较差异具有统计学意义,其与E、Ea、Sa、PSV、RV-SV等右心室功能常用指标测值呈显著正相关(P0.05),但与RVEF组间比较差异不具有统计学意义(P0.05)。结论:组织多普勒技术的应用为胎儿心功能的测定提供了一个全新的方法,其测量方法简便快捷,一个频谱即可综合反映心室的收缩及舒张功能。由于测量的是三尖瓣的机械运动,它可以减少瓣口血流充盈方式的不同(如心率、前负荷的改变)而出现的差异,可广泛应用。f-TAPSE同样可以作为定量反映胎儿右心室舒张及收缩功能的指标。f-TAPSE的测量简便、快捷,对仪器和技术要求不高,且本研究得出了中晚孕组f-TAPSE的参考值范围,中孕组f-TAPSE参考值范围:3.21~6.12,晚孕组f-TAPSE参考值范围:4.74~9.68。
[Abstract]:Objective: To study the frequency spectrum of the tricuspid ring in the normal middle and late pregnant fetus by tissue Doppler velocity imaging (TVI), that is, the systolic and early diastolic, the late peak velocity, and the common measurement index of the right ventricle. The feasibility of evaluation of right ventricular systolic and diastolic function and its variation with the gestational week were analyzed. In this paper, the systolic and systolic displacement (f-TAPSE) of the fetal tricuspid valve in the normal and different gestational weeks was measured by using the anatomic M-mode (FAM), and the application value of the index of the right ventricular contraction and the diastolic function and the change of the gestational week were analyzed. And a reference range of the measurement values of the normal fetus, the pregnant group and the late pregnancy group f-TAPSE was established. Methods:135 cases of normal fetal ultrasound were selected to detect the pregnancy complications of heart and other organs, except for pregnant women, such as diabetes, hypertension, etc., and the pregnant women had accurate stop history, or the fetus that was in accordance with the gestational weeks estimated by the ultrasonic examination, divided into 4 groups according to different gestational weeks:20-24 + 6d, 25-29 + 6d,30-34 + 6d,35-40 weeks. The systolic peak velocity (Sa) and early diastolic peak velocity (Ea) and the late diastolic peak velocity (Aa) were measured by TVI, and the common measurement indexes of Ea, Aa, Sa and right ventricular function were measured: The early diastolic peak velocity (E), peak systolic velocity (A), peak systolic velocity (RV-SV), and right ventricular ejection fraction (RV-SV), and right ventricular ejection fraction (RV-SV), the early diastolic peak velocity (E), the peak systolic velocity (PSV), the right ventricular stroke volume (RV-SV), and the right ventricular ejection fraction (RV-SV), RVEF was used to measure f-TAPSE at the level of tricuspid annulus, and its relationship with the common measurement index of right ventricular function was analyzed. A single-factor analysis of variance was used for the comparison of f-TAPSE and right ventricular function in different gestational age (GA) groups, and Pearson correlation analysis was used for the correlation analysis between the factors. Results:1. The normal right ventricular measurement index E, A, PSV and RV-SV of the normal middle-and-late-pregnant fetus increased with the increase of the gestational period, and the E/ A ratio gradually increased with the gestational period to 1, but the change of the RVEF with the gestational period was not obvious. The differences of Ea, Aa, Ea/ Aa and Sa between the different gestational weeks of the normal and late-pregnant fetuses were of statistical significance (P = 0.000). The Ea/ Aa ratio increased from 0.41-0.08 (20 weeks) to 0.73-0.03 (40 weeks) during the whole pregnancy, and Ea/ Aa was always 1, This is consistent with the change of the E/ A ratio of the blood flow velocity of the tricuspid valve. And the Doppler measurement values Ea and Aa have good correlation with the right ventricular diastolic function indexes E and A, and the Sa and the right ventricular systolic function index PSV and the RV-SV have good correlation. The difference of f-TAPSE between the different gestational weeks of the normal and late-pregnant women was statistically significant, which was positively correlated with the common index values of the right ventricular function such as E, Ea, Sa, PSV, RV-SV (P0.05), but the difference between the two groups was not statistically significant (P0.05). Conclusion: The application of tissue Doppler technique provides a new method for the determination of fetal heart function. Because of the measurement of the mechanical movement of the tricuspid valve, it can reduce the difference in the blood flow filling method of the orifice (such as heart rate, change of the previous load), and can be widely used. F-TAPSE can also be used as a quantitative indicator of the right ventricular diastolic and systolic function of the fetus. F-TAPSE was simple and fast to measure, and the requirement of f-TAPSE was not high, and the reference range of f-TAPSE was 3.21-6.12, and the reference range of f-TAPSE was 4.74-9.68 in the late-pregnant group.
【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】：R445.1;R714.5
[Abstract]:Objective: To study the frequency spectrum of the tricuspid ring in the normal middle and late pregnant fetus by tissue Doppler velocity imaging (TVI), that is, the systolic and early diastolic, the late peak velocity, and the common measurement index of the right ventricle. The feasibility of evaluation of right ventricular systolic and diastolic function and its variation with the gestational week were analyzed. In this paper, the systolic and systolic displacement (f-TAPSE) of the fetal tricuspid valve in the normal and different gestational weeks was measured by using the anatomic M-mode (FAM), and the application value of the index of the right ventricular contraction and the diastolic function and the change of the gestational week were analyzed. And a reference range of the measurement values of the normal fetus, the pregnant group and the late pregnancy group f-TAPSE was established. Methods:135 cases of normal fetal ultrasound were selected to detect the pregnancy complications of heart and other organs, except for pregnant women, such as diabetes, hypertension, etc., and the pregnant women had accurate stop history, or the fetus that was in accordance with the gestational weeks estimated by the ultrasonic examination, divided into 4 groups according to different gestational weeks:20-24 + 6d, 25-29 + 6d,30-34 + 6d,35-40 weeks. The systolic peak velocity (Sa) and early diastolic peak velocity (Ea) and the late diastolic peak velocity (Aa) were measured by TVI, and the common measurement indexes of Ea, Aa, Sa and right ventricular function were measured: The early diastolic peak velocity (E), peak systolic velocity (A), peak systolic velocity (RV-SV), and right ventricular ejection fraction (RV-SV), and right ventricular ejection fraction (RV-SV), the early diastolic peak velocity (E), the peak systolic velocity (PSV), the right ventricular stroke volume (RV-SV), and the right ventricular ejection fraction (RV-SV), RVEF was used to measure f-TAPSE at the level of tricuspid annulus, and its relationship with the common measurement index of right ventricular function was analyzed. A single-factor analysis of variance was used for the comparison of f-TAPSE and right ventricular function in different gestational age (GA) groups, and Pearson correlation analysis was used for the correlation analysis between the factors. Results:1. The normal right ventricular measurement index E, A, PSV and RV-SV of the normal middle-and-late-pregnant fetus increased with the increase of the gestational period, and the E/ A ratio gradually increased with the gestational period to 1, but the change of the RVEF with the gestational period was not obvious. The differences of Ea, Aa, Ea/ Aa and Sa between the different gestational weeks of the normal and late-pregnant fetuses were of statistical significance (P = 0.000). The Ea/ Aa ratio increased from 0.41-0.08 (20 weeks) to 0.73-0.03 (40 weeks) during the whole pregnancy, and Ea/ Aa was always 1, This is consistent with the change of the E/ A ratio of the blood flow velocity of the tricuspid valve. And the Doppler measurement values Ea and Aa have good correlation with the right ventricular diastolic function indexes E and A, and the Sa and the right ventricular systolic function index PSV and the RV-SV have good correlation. The difference of f-TAPSE between the different gestational weeks of the normal and late-pregnant women was statistically significant, which was positively correlated with the common index values of the right ventricular function such as E, Ea, Sa, PSV, RV-SV (P0.05), but the difference between the two groups was not statistically significant (P0.05). Conclusion: The application of tissue Doppler technique provides a new method for the determination of fetal heart function. Because of the measurement of the mechanical movement of the tricuspid valve, it can reduce the difference in the blood flow filling method of the orifice (such as heart rate, change of the previous load), and can be widely used. F-TAPSE can also be used as a quantitative indicator of the right ventricular diastolic and systolic function of the fetus. F-TAPSE was simple and fast to measure, and the requirement of f-TAPSE was not high, and the reference range of f-TAPSE was 3.21-6.12, and the reference range of f-TAPSE was 4.74-9.68 in the late-pregnant group.
【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】：R445.1;R714.5
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