M型超声心动图测量中晚孕正常胎儿三尖瓣环位移评价胎儿右心室功能  

Tricuspid annular plane systolic excursion in evaluation of right heart systolic function of fetuses in second and late trimester with conventional M-mode and free angle M-mode echocardiography

作　　者：郭显峰[1] 赵博文[1] 邱俊芬[1] 王蓓[1] 彭晓慧[1] 潘美[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2期113-117,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 应用解剖M型超声心动图（free angle M-mode,FAM）测量不同孕周胎儿三尖瓣环运动位移（tricuspid annular plane systolic excursion,TAPSE）,探讨其评估右室功能的有效性并建立测值参考范围.方法 选取243例胎儿,根据不同孕周分成5组：20～24周,24^＋1～28周,28^＋1～32周,32^＋1～36周,36^＋1～40周,分别应用普通M型超声心动图（conventional M-mode,CM）及FAM测量胎儿TAPSE,组织多普勒（TDI）测量三尖瓣环舒张早期峰值速度（Em）及收缩期峰值速度（Sm）,并测量有心室短轴缩短率（FS）.不同孕周间CM-TAPSE、FAM-TAPSE、Em、Sm、FS比较采用方差分析,CM-TAPSE与FAMTAPSE的比较采用配对t检验,CM-TAPSE及FAM-TAPSE分别与孕周、Em、Sm、FS间进行Pearson相关分析.结果 不同孕周间CM-TAPSE、FAM-TAPSE、Em、Sm组间比较差异均有统计学意义（P=0.000）,FAM-TAPSE值均高于CM-TAPSE（P=0.000）,FAM-TPASE和CM-TAPSE均与孕周、Em、Sm呈显著正相关,但FAM-TAPSE的相关性更好.结论 FAM通过调整角度,测得三尖瓣环垂直方向最大位移,可以更真实、有效地评价胎儿右室功能.Objective To evaluate the usefulness of free angle M-mode echocardiography （FAM） in obtaining tricuspid annular plane systolic excursion （TAPSE） for assessing the fetal right ventricular function,and to compare the results of measurements of TAPSE by conventional M-mode（CM） and FAM.Methods Two hundred and forty-three normal fetuses in second and late trimester were divided into 5 groups by gestational age（GA）：20-24 weeks,24^＋1-28 weeks,28^＋1-32 weeks,32^＋1-36 weeks,36^＋1-40 weeks.The TAPSE were measured by CM and FAM echocardiography,meanwhile multiple parameters for evaluating right ventricular function were obtained by using myocardial tissue Doppler imaging （TDI）,and the correlation between TAPSE and other parameters were analyzed by linear correlation.ANOVA was used to compare CM-TAPSE,FAM-TAPSE,Em,Sm and right ventricular fractional shortening（RVFS）with different GA.Regression equation estimate was used to compare the relationship of FAM-TAPSE with GA.Independent sample t test was used to compare CM TAPSE with FAM TAPSE.Results There were significant differences in CM-TAPSE,FAM-TAPSE,Em,and Sm among 5 groups （P =0.000）,the measured value of FAM-TAPSE was higher than that of CM TAPSE （P =0.000）.Both FAM-TPASE and CM-TAPSE showed significant positive correlations with GA,Em and Sm,but FAM TAPSE demonstrated better correlation than CM-TAPSE.Conclusions By adjusting sample line of FAM,measuring the maximum displacement of tricuspid annular plane is feasible,and FAM may evaluate fetal right ventricular function more accurately and effectively.

关 键 词：超声检查 产前 三尖瓣环位移 心室功能 右 解剖M型超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]