多普勒超声心动图对胎儿充血性心衰的研究  

Doppler Echocardiographic Study of Fetal Congestive Heart Failure

作　　者：王鸿[1] 耿丹明[1] 洪俊峰[1] 涂学军[1] 

机构地区：[1]解放军南京军区福州总医院超声科,福州市350025

出　　处：《中国超声医学杂志》2005年第8期619-621,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用多普勒超声心动图研究、探讨胎儿充血性心力衰竭(CHF)的病变机制,为早期宫内诊断和治疗及疗效评价提供准确依据。方法超声心动图检出并诊断41例CHF胎儿及正常对照组50例。结果(1)41例胎儿中先天性心脏病14例;重症心律失常15例,胎儿肿瘤5例,双胎输血综合征5例和胎儿贫血2例;(2)均出现胎儿水肿;心脏显著肥厚扩大,表现为心胸比例增大,心房、心室的不对称增大或心肌肥厚。心室缩短率(FS%)及心输出量(CCO)降低(P<0.001);(3)中至重度二、三尖瓣返流(MRTR),9例肺动脉瓣返流;(4)32例胎儿脐动脉PI值增高或舒张期血流相消失及大脑中动脉PI值降低。37例出现脐静脉搏动性血流及41例均示下腔静脉内径增宽及血流频谱改变。结论应用多普勒超声心动图评价胎儿CHF的导致因素,通过主动脉和肺动脉CO的总和CCO可无创获得心输出量的指标及计算FS以达到量化胎儿心功能的目的。可直观地显示胎儿心脏结构,检测瓣膜返流及评价外周血流动力学变化。Objective To detect the fetal congestive heart failure （CHF） using colour Doppler Echocardiography. Methods A total of 41 fetuses with CHF and 50 control subjects were studied using colour Doppler echocardiography. Results 1.There were 29 fetuses with moderate and severe dropsy in the 41 fetuses. 2. All the fetuses showed severe cardiac hypertrophy, such as increased cardiothoracic area ratio ,asymmetrical atrium and ventricle, ventricular wall hypertrophy, decreased ventricular shortening fraction （FS） and the total cardiac output （CCO） of aorta and pulmonary artery. 3. Severe mitral and tricuspid valvular regurgitation. 4. All the fetuses with CHF showed increased pulsatility index in the umbilical artery and decreased pulsatility index in the middle cerebral artery. Thirty-two fetuses showed abnormal umbilical arterial Doppler flow spectra. Conclusions Doppler echocardiography can quantify the fetal cardiac function through the TCO and FS, immediately display the structures of the fetal heart, inspect the valvular regurgitation of the heart and evaluate the dynamics changes of peripheral blood flow.

关 键 词：多普勒超声心动图 胎儿 充血性心力衰竭 诊断 

分 类 号：R714.5[医药卫生—妇产科学] R540.45[医药卫生—临床医学]