论文部分内容阅读
目的检测患有先天性心脏病的胎儿脑血管阻力变化。方法使用脉冲多普勒超声技术对患有先天性心脏病的胎儿进行大脑中动脉(middle cerebral artery,MCA)及脐动脉(umbilical ar-tery,UA)血流动力学指数测量。包括搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)。计算脑/脐血管阻力指数比(cerebral-to-placental resistance ratio,CPR;CPR=MCA-RI/UA-RI)。研究包括25例胎儿先天性心脏病病例,病例组分为组1:包括胎儿左心发育不良、主动脉狭窄、完全性大血管转位,共12例;组2:包括右心血流阻塞的病例、胎儿肺动脉狭窄、肺动脉闭锁、法洛四联症及Ebstein畸形,共13例。对照组包括100例正常胎儿与病例组按胎龄配对。结果病例组与对照组MCA-PI、UA-PI差异无统计学意义。病例组1MCA-PI低于病例组2(P=0.026)及对照组(P=0.035)。病例组2UA-PI较病例组1升高(P=0.047)。病例组2与对照组MCA-PI,UA-PI差异无统计学意义。CPR在各病例组间两两比较,差异均无显著性意义。结论运用脉冲多普勒超声技术可检测到部分患有先天性心脏病的胎儿存在脑血管阻力降低的变化,不同类型的心脏畸形可能引起胎儿脑血管不同程度的代偿反应。
Objective To detect fetal vascular resistance changes in children with congenital heart disease. Methods The fetal hemodynamics of middle cerebral artery (MCA) and umbilical ar-tery (UA) were measured by pulsed Doppler ultrasound in fetuses with congenital heart disease. Including pulsatility index (PI), resistance index (resistance index, RI). The cerebral-to-placental resistance ratio (CPR; CPR = MCA-RI / UA-RI) was calculated. The study included 25 cases of fetal congenital heart disease, the case group is divided into group 1: including fetal left heart dysplasia, aortic stenosis, complete vascular transposition, a total of 12 cases; group 2: including right heart obstruction Cases, fetal pulmonary artery stenosis, pulmonary atresia, tetralogy of Fallot and Ebstein’s deformity, a total of 13 cases. The control group consisted of 100 normal fetuses and the case group matched by gestational age. Results There was no significant difference between MCA-PI and UA-PI in case group and control group. The case group 1MCA-PI was lower than the case group 2 (P = 0.026) and the control group (P = 0.035). The 2UA-PI in case group was higher than that in case group 1 (P = 0.047). Case group 2 and control group MCA-PI, UA-PI difference was not statistically significant. There was no significant difference in CPR between the two groups. Conclusions The changes of cerebrovascular resistance in some fetuses with congenital heart disease can be detected by pulsed Doppler ultrasound. Different types of cardiac malformations may cause different degrees of compensatory responses to fetal cerebrovascular disease.