妊娠早期超声胎儿心脏血流动力学变化与染色体畸形关系的初步研究  

Fetal cardiac hemodynamic changes and its relationship with chromosomal abnormalities in the first trimester

作　　者：黄晶晶[1] 桂永浩[1] 常才[2] 孙莉[2] 刘豫阳[1] 宁寿葆[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032 [2]复旦大学附属妇产科医院

出　　处：《中华围产医学杂志》2004年第6期323-326,i001,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的　了解人类妊娠早期胎心血流动力学变化的规律 ,初步筛查出与染色体畸形可能相关的血流讯号。　方法　采用经阴道二维 +多普勒超声技术对 172例妊娠早期正常孕妇的胚胎 /胎儿心脏进行研究 ,得出正常参数 ;随之对 10 2 2例行人工流产的孕妇胚胎 /胎儿心脏进行探查 ,总结异常变化并进行绒毛染色体分析。　结果　 (1)妊娠早期胎心血流动力学的变化 :妊娠 7周以前 ,原始心搏引起的多普勒讯号表现为单一峰值 ;妊娠 7周后 ,可观察到流入流出道方向相反的血流 ,通过流入道的血流流速波形为单峰 ;妊娠第 9周起 ,通过流入道的血流流速波形开始呈现双峰 ,e峰出现 ;胎心率早期随胎龄增加而增快 ,第 10周时最快 ,之后则有所减慢。 (2 )观察到 2 7例胎儿心脏血流动力学异常 ,其中 9例核型分析结果异常 (3例心动过缓 ,4例半月瓣返流 ,2例房室瓣返流 )。结论　妊娠早期胎儿心脏可用高频率经阴道超声进行观察 ,其血流动力学变化存在时相性特征。早期超声探及心动过缓、出现瓣膜返流讯号的胚胎 /胎儿与染色体畸形有一定相关性。Objective To study the hemodynamic changes in normal fetal heart in the first trimester and to find out the possible blood flow signals related with chromosomal abnormalities. Methods One hundred and seventy two normal pregnant women were selected for fetal echocardiographic examination between 7 and 12 weeks gestation to establish the normal range;1022 fetuses were checked later and chromosome analysis was performed for those who had abnormal cardiac hemodynamic changes. Results Fetal cardiac hemodynamic changes demonstrated: before 7 weeks of gestation, Doppler signal caused by primitive heart beating showed simple wave; from 7 weeks, the in and outflow tract was in oppsite direction and the inflow tract velocity wave was monophasic The inflow tract velocity wave changed from monophasic to biphasic since 9 weeks of gestation and ‘e’ wave appeared. The fetal heart rate increased with the progress of pregnancy before 10 weeks,reached its peak at 10 weeks and decreased gradually thereafter. Abnormal karyotypes were detected in 9 fetuses among 27 with abnormal hemodynamics(3 tachycardia, 4 semilunar valve regurgitation and 2 atrioventricular regurgitation). Conclusions The gestational age related hemodynamic changes in fetal heart blood flow in the first trimester can be screened by transvaginal doppler ultrasonography. Signals of tachycardia and regurgitation of fetal heart were associated with fetal chromosomal abnormalities.

关 键 词：胎儿心脏 血流动力学 畸形 返流 妊娠早期 超声 观察 变化 结论 初步研究 

分 类 号：R714.5[医药卫生—妇产科学]