先心病胎儿及正常胎儿颅内结构容积的三维超声研究

发布时间：2018-03-22 04:18

  本文选题：三维容积超声　切入点：胎儿颅脑　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：先天性心脏病是最常见的胎儿畸形,而神经系统发育以及功能异常普遍存在于先心病患儿中。已有研究证实不仅手术中及术后的许多因素对先心病儿童的神经系统产生损害,先心病患儿在手术前甚至在宫内已经存在大脑的发育异常或脑损伤。因此,对先心病胎儿进行大脑发育的评价具有重要意义及临床价值。 研究目的：应用三维超声测量不同孕周胎儿额叶及丘脑容积,建立正常胎儿额叶及丘脑容积的生长曲线。探讨先心病胎儿与正常胎儿额叶及丘脑容积之间可能存在的差异,及脑血流与脑容积变化的相关性。 对象及方法：随机选取2013-2014年于本院超声科进行产科超声检查的孕妇246例,其中正常胎儿172例,产前诊断为先心病胎儿74例。应用三维超声成像技术及VOCAL容积分析程序测量胎儿额叶及丘脑三维容积,并获得大脑中动脉及脐动脉的血流动力学参数PI及CPR。评价正常胎儿额叶及丘脑三维容积与孕周及颅脑二维生长参数(BPD/HC)的相关性,并建立额叶及丘脑容积随孕周增长的回归模型。比较正常组与先心病组胎儿额叶及丘脑容积差异,并探讨脑血流与脑容积变化的相关性。 结果：成功获取242例胎儿颅脑三维容积,其中正常胎儿168(168/172)例,平均孕龄28.20±4.44,先心病胎儿73(73/74)例,平均孕龄28.15±4.04周。1.正常胎儿额叶及丘脑容积与孕周、双顶径及头围密切相关(P0.0001),额叶及丘脑容积随孕周呈S曲线增长,回归方程：额叶容积=e(7.393-100.037*孕周’(R2=0.965,P0.0001),丘脑容积=e(4.823-111.718*孕周)(R2=0.983,P0.0001)。2.在孕晚期(≥30周),先心病组胎儿(23/73例)额叶及丘脑容积较正常组胎儿(63/168例)减小(P0.001,P0.05),额叶容积差异在经头围标准化后仍然显著(P0.001)。3.先心病胎儿组MCA-PI及CPR较正常胎儿组降低(P0.05, P0.001), CPR的减小与额叶及丘脑容积的减小关系密切(R=0.618,0.634,P0.001)。 结论：三维超声可用于测量胎儿颅内结构容积,具有操作性及可重复性。先心病在宫内即影响胎儿大脑发育,导致晚孕期胎儿额叶及丘脑容积相对减小,其原因可能与先心病胎儿脑血流动力学的改变相关。
[Abstract]:Background: congenital heart disease is the most common fetal malformation. However, abnormal development and function of nervous system are common in children with congenital heart disease. It has been proved that many factors, not only during surgery but also after operation, can damage the nervous system of children with congenital heart disease. The abnormal development of brain or brain injury exists in children with congenital heart disease before operation and even in the uterus. Therefore, it is of great significance and clinical value to evaluate the development of brain in infants with congenital heart disease. Objective: to measure the frontal lobe and thalamus volume of fetuses of different gestational weeks and to establish the growth curve of normal fetal frontal lobe and thalamus by three-dimensional ultrasound, and to explore the possible difference between fetal frontal lobe and thalamus volume of congenital heart disease and normal fetus. And the correlation between cerebral blood flow and cerebral volume. Participants and methods: a total of 246 pregnant women, including 172 normal fetuses, were randomly selected for obstetric ultrasound examination in our hospital from 2013 to 2014. Three-dimensional ultrasound imaging and VOCAL volumetric analysis program were used to measure the three-dimensional volume of frontal lobe and thalamus in 74 cases of congenital heart disease diagnosed by prenatal diagnosis. The hemodynamic parameters Pi and CPRof middle cerebral artery and umbilical artery were obtained to evaluate the correlation between the three-dimensional volume of frontal lobe and thalamus of normal fetus and the two-dimensional growth parameters (BPD / HCC) of gestational and craniocerebral. A regression model of frontal lobe and thalamus volume with gestational weeks was established to compare the difference of fetal frontal lobe and thalamus volume between normal group and congenital heart disease group, and to explore the correlation between cerebral blood flow and cerebral volume. Results: a total of 242 cases of fetal brain volume were successfully obtained, of which 168 cases were normal fetuses, 168 cases were normal fetuses, the average gestational age was 28.20 卤4.44, the mean gestational age of congenital heart disease fetus was 73% 73 / 74, the mean gestational age was 28.15 卤4.04 weeks .1.The normal fetal frontal lobe and thalamus volume and gestational week. The bilateral parietal diameter and head circumference were closely related to P0.0001, and the volume of frontal lobe and thalamus increased with gestational weeks. The regression equation is: frontal lobe volume is 7.393-100.037 * gestational volume is 0.965U P0.0001, thalamus volume is 4.823-111.718* gestational age is 4.823-111.718. the difference of frontal lobe volume and thalamus volume is reduced in the third trimester of pregnancy (鈮，

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