三尖瓣瓣环位移对正常中晚孕胎儿右心室功能的定量研究  

Quantitative study of right ventricular function in the normal second and third trimester fetuses by M-mode tricuspid annular displacement

作　　者：蒋贤辉[1,2] 赵博文[1] 王蓓[1] 潘美[1] 杨园[1] 苏杭[1] 周林玉[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科浙江大学邵逸夫临床医学研究所,杭州310016 [2]杭州市中医院超声科,310007

出　　处：《中华超声影像学杂志》2012年第10期833-837,共5页Chinese Journal of Ultrasonography

基　　金：浙江省自然科学基金项目（Y2080080）

摘　　要：目的应用M型超声心动图测量正常中晚孕胎儿三尖瓣瓣环位移（tricuspid annular displacement，TAD），建立其正常参考范围并探讨TAD对正常中晚孕胎儿右室功能的定量研究价值。方法选取161例孕龄19-38周正常中晚孕单胎妊娠胎儿。应用M型超声心动图测量TAD；频谱多普勒（PW）测量三尖瓣口舒张早期血流峰值速度（E）、舒张晚期血流峰值速度（A）；组织多普勒（TDI）测量三尖瓣环舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）及收缩期峰值速度（Sm）。结果正常中晚孕胎儿TAD值为（9．38±1．71）mm，95％正常参考值范围分别为5．79～13．90mm。TAD与孕周、E、A及Em、Am、Sm间呈显著相关性，r值分别为0．759、0．547、0．320、0．497、0．483和0．598（P〈0．001），与心率间无相关性（P〉0．05）。晚孕组TAD值大于中孕组，差异有统计学意义（P〈0．05）。结论正常中晚孕胎儿TAD值随孕周增加而增长，其评价胎儿右室功能与Pw三尖瓣口E、A峰值流速及TDI三尖瓣瓣环Em、Am、Sm等传统右室功能评价参数有良好的相关性。TAD具有测量简单、可重复性高、对超声仪器要求低等优点，利于各级医院推广，并可能成为一些由于超声仪器没有多普勒测量功能的基层医院今后评价胎儿右室功能的主要参数之一。Objective To quantitatively study right ventricular function in the normal second and third trimester fetuses by M-mode tricuspid annular displacement（TAD）. Methods TAD was measured using conventional M-mode echocardiography on 161 normal second and third trimester fetuses with gestation age （GA） between 19- 38 weeks,meanwhile multiple parameters for evaluating right ventricular function were obtained using pulsed Doppler echocardiography （PW） and myocardial Dopple tissue imaging （DTI）. The correlation between TAD and other parameters were analyzed using SPSS 17.0. Results In normal second and third trimester fetuses, the TAD was （9.38 ± 1.71）mm with a range of 5.79 - 13.90 mm,and was increased with the growth of GA. TAD was correlated with GA, E, A, Era, Am and Sm significantly （ r = 0. 759,0. 547,0. 320,0. 497,0.483 and 0. 598 respectively,all P d0. 001）. TAD was not correlated with HR（ P 〉0.05）. TAD showed differences between the second trimester fetuses and the third trimester fetuses （ P 〈 0. 05）. Conclusions In normal second and third trimester fetuses, the TAD is increased with the growth of GA,and has good correlation with GA,E,A,Em,Am and Sm respectively,and may become a new promising modality to evaluate function of RV simply and accurately. The technique will be propitious to use in hospitals （without DTI） because of simplicity of operator and lower requirement on the technology and equipment precision.

关 键 词：超声心动描记术 胎儿 心室功能 右 三尖瓣瓣环位移 

分 类 号：R445.1[医药卫生—影像医学与核医学]