组织多普勒成像技术及Tei指数评价脐绕颈胎儿及单纯性单脐动脉胎儿右室功能的研究

发布时间：2018-01-15 04:09

  本文关键词：组织多普勒成像技术及Tei指数评价脐绕颈胎儿及单纯性单脐动脉胎儿右室功能的研究　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 脐带绕颈胎儿 单纯性单脐动脉胎儿 组织多普勒成像技术 Tei指数 右室收缩功能 右室舒张功能

【摘要】：目的: 运用组织多普勒成像技术（Tissue Doppler Imaging，TDI）及Tei指数评价脐绕颈胎儿(umbilieal cord around neck，UCAN)及单纯性单脐动脉胎儿（simple single umbilical artery SUA）的右室收缩功能和舒张功能，为脐绕颈及单纯性单脐动脉胎儿的产前咨询和临床处理提供依据。 方法: 研究对象：选自孕龄23-40周（平均孕龄28.4±3.9周）的59名孕妇，孕妇年龄21-35岁（平均年龄27.3±4.0岁），共分为三组。 经胎儿系统超声确认为脐带绕颈但无胎儿宫内窘迫，为脐带绕颈组(A组)，共16例。平均孕龄28.4±3.4周，孕妇年龄21-30岁，平均年龄26.6±4.0岁；经胎儿系统超声检查确认为单纯单脐动脉，为单脐动脉组(B组)，共15例。平均孕龄28.8±3.3周，孕妇年龄22-33岁，平均年龄26.9±4.1岁；经胎儿系统超声及胎儿超声心动图检查，确认无心内外结构畸形及宫内发育迟缓，为正常对照组，共28例。平均孕龄28.2±3.8周，孕妇年龄21-35岁，平均年龄27.8±4.0岁；入选标准：首先是胎儿条件：早期均作过胎儿系统超声检查，证实胎龄与孕周相符；且经过胎儿系统超声及胎儿心动超声筛查无心内外结构畸形及宫内发育迟缓；其次是孕妇条件：经询问病史及以往体检和查看孕妇保健记录本和检查结果，确认孕妇身体健康，无吸烟、嗜酒史，无高血压、糖尿病史，无心、肝、肾等慢性疾病史，无先心病生育史和家族史。无服用消炎痛等非甾体类抗炎药物史。 使用仪器：使用GE VIVID E9型彩色多普勒超声诊断仪，采用6S探头,探头频率2.5-6MHz，该仪器具有TDI程序。 图像储存：平静呼吸条件下，嘱所有孕妇在平卧或侧卧的舒适状态下，选择胎动不频繁时在二维模式下获取标准而清晰的胎儿四腔心切面，首先在普通二维模式下，打出清晰四腔心，将取样容积置于三尖瓣口右室侧， 启动PW键，获取连续5个以上的胎儿心动周期的舒张期三尖瓣口血流频谱图，储存；其次同在二维模式下，启动M型超声功能键，将取样线置于三尖瓣环与右室游离壁交界处，连续扫描5个以上的胎儿心动周期稳定的三尖瓣环位移图(Tricuspid annular plane systolic excursion TAPSE），储存待以后分析。启动TDI功能键，切换至脉冲多普勒（PW），将取样线置于三尖瓣环与右室游离壁交界处，尽量使声束与心肌纵向运动平行,连续扫描5个以上的胎儿心动周期稳定的三尖瓣环组织多普勒频谱图，储存待以后分析。最后，在二维模式下，打出清晰的肺动脉长轴切面，将取样线置于肺动脉瓣上，启动PW键，获取连续5个以上的胎儿心动周期的收缩期肺动脉瓣口血流频谱图。 图形分析及参数测量： 1三尖瓣口血流频谱（PW）：测量三尖瓣口舒张舒张期早期峰值速度（E，cm/s）；舒张期晚期峰值速度（A，cm/s）；并计算E/A。将前一周期的A峰结束至下一周期E峰开始的时间间期记为（a，ms）。 2肺动脉瓣口血流频谱（PW）：将收缩期肺动脉瓣血流峰值所占时间（射血时间ejection time, ET）记为（b，ms）;a-b为等容收缩期时间（isovolumetriccontraction time,ICT）与等容舒张期时间（isovolumetric relaxationtime,IRT）之和。 3右心室p-tei指数=（ICT+IRT）/ET；即右心室p-tei指数=（a-b）/b。 4三尖瓣环组织多普勒频谱图（TDI）：测量收缩期峰值速度（s′，cm/s）；舒张期早期峰值速度（e′，cm/s）；舒张期晚期峰值速度（a′，cm/s）；并计算e′/a′和E/e′。 以上测量均由同一检查者操作，为尽量减少心率波动的影响，每一测量参数均以连续测量三个心动周期取测平均值。 统计分析 所有数据应用SPSS13.0统计学软件分析，计量资料以平均数±标准差表示，计数资料以百分率表示，先对各组样本进行正态性检验，经检验上述样本均满足正态性，再对脐带绕颈组、单脐动脉组与正常对照组间指标比较采用方差分析，同时各组由于病例数较少还需进行方差齐性检验，正态性检验及方差齐性检验的检验水准一般较保守，常取0.10或0.20。方差分析按a=0.05的水准，以P0.05时差异有统计学意义。 结果： 共对59例孕妇进行了64次胎儿超声心动图检查，其中有5例孕妇进行了2次检查。 1各组间一般资料比较 三组间孕妇年龄、心率及脐动脉S/D比值相比较差异无统计学意义（P＞0.05)。 2右心室整体功能p-tei指数比较 A组高于正常对照组，差异具有统计学意义（P＜0.05)；A组高于B组，差异具有统计学意义（P＜0.05)；B组与正常对照组比较，差异无统计学意义（P＞0.05)； 3右心室功能各参数比较 3.1右心室收缩功能各参数结果 三组间TAPSE值差异无统计学意义（P＞0.05)；三组间s′值差异无统计学意义（P＞0.05)； 3.2右心室舒张功能各参数结果 三组间的E/A、e′/a′、E/e′比值差异均无统计学意义（P＞0.05)； 4各参数与孕周的关系 胎儿右心室E/A、e′/a′、TAPSE、s′值随孕周增大而增大，E/e′、Tei指数及胎心率（FHR）随孕周增大而减小，差异有统计学意义（P＜0.05)； 结论： 1脐带绕颈胎儿p-tei指数要高于无脐带绕颈的正常胎儿，，因此，通过测量p-tei指数可以监测脐带绕颈胎儿心室收缩功能和舒张功能，进而通过p-tei指数的变化可以发现脐带绕颈时胎儿心功能异常的改变，提示脐带绕颈胎儿右室整体功能比正常对照组略减低； 2单脐动脉组与正常对照组的右室收缩功能与舒张功能无明显差异；故单脐动脉胎儿如不合并心内外畸形，与正常胎儿无异。 3胎儿右心室E/A、e′/a′、TAPSE、s′随孕周增大而增大，E/e′、Tei指数及胎心率（FHR）随孕周增大而减小。
[Abstract]:Objective:
The use of Doppler tissue imaging (Tissue Doppler, Imaging, TDI) and Tei index in the evaluation of fetal umbilical cord around the neck (umbilieal cord around neck, UCAN) and simple single umbilical artery (simple single umbilical artery SUA) of the right ventricular systolic and diastolic function, provide the basis for the umbilical cord around the neck and prenatal counseling of simple single umbilical fetal arterial and clinical treatment.
Method:
Subjects: 59 pregnant women were selected from 23-40 weeks of gestational age (average gestational age of 28.4 + 3.9 weeks). The age of pregnant women was 21-35 years (average age 27.3 + 4 years). It was divided into three groups.
The fetal ultrasound system confirm the umbilical cord around the neck but no fetal distress, umbilical cord around the neck group (A group), a total of 16 cases. The average gestational age was 28.4 + 3.4 weeks pregnant women, aged 21-30 years, mean age 26.6 + 4 years old; the fetal system ultrasonography confirmed as simple as single umbilical artery, vein group dynamic single umbilical (B group), a total of 15 cases. The average gestational age was 28.8 + 3.3 weeks pregnant women, aged 22-33 years, mean age 26.9 + 4.1 years; by fetal system ultrasonography and fetal echocardiography confirmed without congenital malformations and intrauterine growth retardation, normal control group, a total of 28 cases. The average pregnancy at the age of 28.2 + 3.8 weeks pregnant women, aged 21-35 years, mean age 27.8 + 4 years; inclusion criteria: the first is to have fetal conditions: early fetal system ultrasonography confirmed, gestational age and gestational age; and after fetal system ultrasonography and fetal echocardiography screening without congenital malformations and intrauterine growth retardation The second is: the condition of pregnant women; history and past medical and health records of the pregnant women check and examination results, confirm the health of pregnant women, no smoking, alcohol abuse, hypertension, diabetes, heart, liver, kidney and other chronic diseases, no family history and family history of congenital heart disease. Without taking indomethacin and other non steroidal nonsteroidal anti - inflammatory drug history.
Use instrument: use GE VIVID E9 color Doppler ultrasonic diagnostic instrument, use 6S probe, probe frequency 2.5-6MHz, this instrument has TDI program.
Image storage: quiet breathing conditions, will all pregnant women in the supine or side comfort conditions, choose do not frequent movement when in the two-dimensional models obtain the standard and clear fetal four chamber view, first in the two-dimensional mode, play clear four chamber, the sample volume placed three tricuspid valve mouth right ventricular side,
Start the PW button, get 5 or more consecutive fetal cardiac cycle three diastolic tricuspid orifice flow chart, storage; secondly in two-dimensional mode, start the M type ultrasonic function keys, the sampling lines placed in three tricuspid annulus and right ventricular free wall junction, three tricuspid annular displacement diagram of continuous scanning 5 the fetal cardiac cycle stable (Tricuspid annular plane systolic excursion TAPSE), storage until after the analysis. Start TDI function key, switch to the pulse Doppler (PW), the sampling lines placed in three tricuspid annulus and right ventricular free wall junction, try to make the sound beam and myocardial longitudinal parallel, three tip valve ring Doppler spectrum continuous scanning more than 5 fetal cardiac cycle stability, storage for later analysis. Finally, in the two-dimensional mode, with long axis view of pulmonary artery clearly, the sampling lines placed in the pulmonary valve, start the PW key, get 5 consecutive The systolic blood flow spectrum of the pulmonary artery in the systolic phase of the fetal heart cycle above.
Graphic analysis and parameter measurement:
1 three cusp mouth blood flow spectrum (PW): measure three cusp mouth diastolic early peak speed (E, cm/s); late diastolic peak velocity (A, cm/s); and calculate E/A., the A peak of the previous period ends to the next period E peak start time interval is (a, MS).
2 pulmonary blood flow spectrum (PW): the systolic pulmonary valve peak flow of time (ejection time ejection time, ET) (B, MS) is A-B; for the isovolumic contraction time (isovolumetriccontraction, time, ICT) and isovolumic relaxation time (isovolumetric relaxationtime, IRT) and.
The 3 right ventricular p-tei index = (ICT+IRT) /ET, that is, the p-tei index of the right ventricle = (a-b) /b.
4 the three Doppler annulus tissue TDI spectrum (s): the systolic peak velocity (s', cm/s), the diastolic peak velocity (E ', cm/s), the late diastolic peak velocity (a', cm/s), and E '/a' and E/e 'were calculated.
The above measurements were performed by the same examiner to minimize the impact of heart rate fluctuations. Each measurement parameter was measured by three consecutive cardiac cycles.
statistical analysis
All data were analysed using SPSS13.0 statistical software, measurement data with the average standard deviation, count data expressed as a percentage, the first test of normality for each sample, the samples were tested to meet the normality of the umbilical cord around neck group, single umbilical artery group and normal control group were compared by variance the analysis, at the same time the groups because of fewer cases need for homogeneity of variance test, test of normality and homogeneity of variance test level is generally conservative, often take 0.10 or 0.20. variance analysis according to the a=0.05 standard, the difference was statistically significant P0.05.
Result锛

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