超声速度向量成像技术在胎儿心律失常诊断及治疗中的初步应用  

Velocity vector imaging application in fetus with arrhythmia:preliminary study

作　　者：王鸿[1] 耿丹明[1] 李慧忠[1] 涂学军[1] 陈哲明[1] 

机构地区：[1]南京军区福州总医院超声科,350025

出　　处：《中华医学超声杂志（电子版）》2007年第5期305-307,共3页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：福建省科技重点课题基金资助[2005I014]

摘　　要：目的探讨超声速度成像(VVI)技术在胎儿心律失常诊断及治疗中的应用价值。方法对24例孕(26.5±5.5)周的心律失常胎儿,其中6例室上性心动过速(3例为阵发性室上性心动过速),18例频发房性早搏,行VVI分析,检测心律失常时胎儿心肌速度向量、应变和应变率变化;另选取30例孕(27.0±6.5)周的正常胎儿作为对照组,对比分析2组胎儿心肌速度向量、应变和应变率变化。结果18例频发房性早搏均呈二、三联律,VVI速度向量图显示早搏与正常窦性心律的心脏扭转角度和方向基本一致,应变与应变率与对照组相比差异无统计学意义(P>0.05)。6例室上性心动过速发作时VVI速度向量示心肌运动向量幅度减低,3例发作持续48h的胎儿(心室率230～310次/min)心肌运动向量幅度显著降低,应变及应变率与正常对照组对比降低(P<0.01),常规超声检查可见胎儿水肿及重度二尖瓣、三尖瓣反流;3例阵发性室上性心动过速胎儿与正常对照组应变及应变率相比差异无统计学意义(P>0.05)。对3例室上性心动过速胎儿经胎盘给药行宫内西地兰、地高辛转律及抗心衰治疗后,1例于10d后转律,呈频发房性早搏;2例于18～24d转律,呈窦性心律,VVI检测心肌速度向量及应变与应变率明显改善。3例室上性心动过速胎儿转律及抗心力衰竭治疗后2例39周剖宫产分娩,1例经阴道分娩;3例阵发性室上性心动过速胎儿及18例频发房性早搏胎儿均经阴道分娩,胎儿各项生理指标及心脏各项检测指标正常。结论VVI技术可实时动态分析胎儿心动过速时的快速心率,通过检测心律失常时胎儿心肌运动向量及应变与应变率改变解析胎儿心律失常。Objective To study the cardiac structural mechanics and hemodynamics in fetus with arrhythmia using velocity vector imaging(VVI)technology,and to evaluate the theraputic effect on arrhythmia.Methods A total of 24 fetuses with arrhythmia and 30 healthy individuals were enrolled.Arrhythmia included supraventricular tachycardia(SVT)in 6 fetuses and frequently premature atrial contractions(PAC)in 18.VVI was used to determinate myocardial mechanics,strain and strain rate.Results Three of 6 fetuses with persistant SVT more than 48 h,heart rate ranged 230-310 and complication of cardiac failure and edema occurred before treatment,and VVI revealed that velocity amplitude was significantly reduced,with low strain and strain rate,compared with the controls(P<0.01).In other SVT fetuses,velocity amplitude reduction was seen but no strain rate changes occurred.In fetuses with PAC,VVI revealed asynchronous motion without velocity amplitude lowering.Three-dimensional color M-mode analysis appeared three-dimensional pattern of premature beats and compensatory pause,but strain and strain rate were found unchanged,compared with the controls(P>0.05).Conclusions VVI could be used to evaluate the cardiac structural mechanics using quantitatively strain and strain rate,and could precisely provide evidence for diagnosis of cardiac dysfunction in fetuses with arrhythmia while ECG is still not definite.

关 键 词：彩色多普勒超声心动描记术 胎儿 心律失常 

分 类 号：R445.1[医药卫生—影像医学与核医学]