解剖M型超声心动图测量中晚孕正常胎儿二尖瓣环位移的研究  

Free angle M-mode echocardiography in evaluation of left ventricular systolic function of fetuses in second and late trimester by mitral annular displacement

作　　者：邱俊芬[1] 赵博文[1] 郭显峰[1] 周维[1] 孙晓露[1] 王蓓[1] 潘美[1] 彭晓慧[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

出　　处：《中华超声影像学杂志》2015年第1期19-23,共5页Chinese Journal of Ultrasonography

基　　金：浙江省科技厅公益性技术应用研究计划项目（2012C33123）

摘　　要：目的应用普通M型（conventionalM-mode，CM）及解剖M型（freeangleM—mode，FM）超声心动图测量中晚孕正常胎儿二尖瓣环位移（mitralannulardisplacement，MAD），并分析两种测量方法测值的差异性及其与孕周、胎儿左心功能参数之间的相关关系。方法选取233例孕龄在18～39周正常中晚孕单胎妊娠孕妇，分别用普通M型及解剖M型超声心动图测量胎儿的MAD，分别记为MADCM及MADFu。应用组织多普勒（TDI）测量二尖瓣瓣环舒张早期峰值流速（Em）、舒张晚期峰值流速（Am）及收缩期峰值流速（Sm），并测量左室短轴缩短率（FS）。定量分析两种测量方法的差异性及MADCM、MADFM与孕周及胎儿左心功能参数之间的相关关系。结果正常中晚孕胎儿MADCM值为（5．69±0．91）mm，MADFM值为（6．78±1．31）mm，差异有统计学意义（P〈0．05）。MADCM、MADFM均与孕周呈显著正相关（P〈O．01），与其他评价左心功能的指数Em、Am、Sm呈正相关（均P〈0．05），但与左室短轴缩短率（LVFS）无显著相关性（P〉0．05）。MADCM与孕周、Em、Am及Sm的相关系数r值分别为0．72、0．46、0．54、0．45；MADFM与孕周、Em、Am及Sm的相关系数r值分别为0．82、0．52、O．67、0．62，MADFM的相关性优于MADCM。对于心尖正前正后位置的胎儿分别用普通M型超声心动图及解剖M型超声心动图测得的MAD差异无统计学意义（P〉0．05），而对于心尖不在正前正后位置的胎儿分别用两种方法测得的MAD差异有统计学意义（P〈0．05）。结论解剖M型超声心动图在测量MAD上与传统M型超声心动图相比具有更高的准确性和重复性，可以更真实有效地评价胎儿左室收缩功能。Objective To measure mitral annular displacement （MAD） by conventional M-mode echocardiography and free angle M-mode echocardiographic measurements respectively in the normal second and third trimester fetuses, and to analyze the differences between the two methods and to explore the correlation of MAD with gestational age and routine parameters for evaluation of fetal left ventricular function. Methods Totally 233 fetuses of gestational age （GA） at 18 to 39 weeks were enrolled. MAD was measured respectively by conventional M-mode （MADcM） and free angle M-mode echocardiography （MADFM）. Tissue Doppler imaging （TDI） was used to measure mitral annulus early diastolic peak velocity （Em）,late diastolic peak velocity （Am） and peak systolic velocity （Sm）. The correlation between the two methods for measurement differences and the correlation between MAD and other routine echoeardiographic parameters were investigated. Results The MADcM was （5.69 ± 0.91） mm,the MADFM was （6.78 ± 1.31） mm（ P 〈0.05）, MADcM and MADAM were found correlated with GA and showed a significant positive correlation （ P ~0.01）,MADcM and MADFM also demonstrated positive correlation （ P 〈0.05） with Em, Am and Sm, and MADrM performed better correlation than MADcM. MAD did not correlated with left ventricular fraction shortening（LVFS） （ P 〉0.05）. No significant difference was found between MADcM and MADFM in fetuses with favorable apical four chamber （ P 〉0.05）, however significant difference was found between MADcM and MADFM in fetuses with unfavorable apical four chamber （P 〈 0.05 ）. Conclusions In comparison with the traditional M-mode echocardiography, MAD obtained with free angle M-mode echocardiography has higher accuracy and repeatability in evaluation of fetal left ventricular systolic function.

关 键 词：超声检查 产前 胎儿 心室功能 左 二尖瓣环位移 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]