多普勒超声心动图对中晚孕胎儿肺动脉收缩压异常增高的随访观察  

The follow-up observation on the abnormal elevation of fetal pulmonary artery systolic pressure at middle and late stages by Doppler echocardiography

作　　者：战鸿雁[1] 尹虹 陶国伟[3] 徐凤芹[1] 刘传玺[4] Zhan Hongyan;Yin Hong;Tao Guowei;Xu Fengqin;Liu Chuanxi(Department of Ultrasound,J inan Fourth People＇s Hospital,Jinan 250031,China)

机构地区：[1]济南市第四人民医院超声科济南市心血管疾病研究所,250031 [2]山东省妇幼保健院超声诊断科 [3]山东大学齐鲁医院超声诊断科 [4]山东省立医院超声诊疗科

出　　处：《中华超声影像学杂志》2018年第9期771-776,共6页Chinese Journal of Ultrasonography

基　　金：山东省济南市科技局科技明星计划（201406017）

摘　　要：目的采用彩色多普勒超声心动图对中晚孕胎儿肺动脉收缩压异常增高的转归进行系统观测。方法选取三尖瓣少量或轻度反流的胎儿95例作为对照组，中度及中度以上三尖瓣反流的胎儿60例作为观察组，应用彩色多普勒超声心动图测量其三尖瓣反流程度、反流速度及反流压差，并计算肺动脉收缩压值，比较两组间基线资料及肺动脉收缩压测量值的差异；对观察组肺动脉收缩压增高（〉20mmHg，1mmHg=0．133kPa）者，每4周对肺动脉收缩压进行重复观测，直到肺动脉收缩压恢复正常为止。结果两组间孕周、三尖瓣反流速度、三尖瓣反流压差和肺动脉收缩压差异均有统计学意义（P〈0．001）。肺动脉收缩压与孕周、三尖瓣反流速度、三尖瓣反流压差均呈正相关（r=0．442，0．998，0．999；均P〈0．001），而与孕妇年龄无相关性（r=-0．001，P=0．674）。随访显示，观察组中47例（78．3％）肺动脉收缩压〈50mmHg，于出生前肺动脉收缩压下降，三尖瓣反流随之消失或仅有轻度反流；13例（21．7%）收缩压≥50mmHg，表现为重度三尖瓣反流，连续观察肺动脉压持续升高，最高测压均≥70mmHg并伴有不同程度右心衰竭征象。出生后的13例胎儿中仅有1例因持续肺动脉高压和缺氧（血氧饱和度低于45％）心肺衰竭死亡，其余12例胎儿肺动脉收缩压于出生后5～105d下降至正常，同时右心功能恢复正常。结论中晚孕胎儿肺动脉收缩压异常增高伴有明显三尖瓣反流现象，为可逆性功能性改变，绝大多数在出生前或提前出生后恢复正常。Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound. Methods Ninety-five fetuses with a little or mild tricuspid regurgitation （control group） and 60 fetuses with moderate and severe tricuspid regurgitation （observation group） were included. The degree, velocity, and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared. As for the follow-up on observation group, the pressure of fetus with high pulmonary systolic pressure （〉20 mmHg） was repeatedly measured every 4 weeks until it return to normal. Results There were significant differences in terms of gestational weeks, velocity and pressure of tricuspid regurgitation, as well as pulmonary systolic pressure between the two groups （P 〈0.001）. Pulmonary systolic pressure was positively correlated with gestational weeks, velocity and pressure of tricuspid regurgitation （ r = 0.442, 0. 998, 0. 999 ; all P % 0. 001 ）, but had no correlations with the age of pregnant women （ r = - 0.001, P = 0.674）. The follow-up revealed that, in observation group, 47 cases （78.3%, systolic pressure 〈 50 mmHg） presented with the decreased pulmonary systolic pressure, the disappeared or the slight appeared regurgitation before birth, meanwhile, 13 （21.7%, systolic pressure 950 mmHg） exhibited severe tricuspid regurgitation and persistent pulmonary elevation, with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure. Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia （oxygen saturation 45%）. The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth, with normal heart function. Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid r

关 键 词：超声心动描记术 多普勒 肺动脉收缩压 中晚孕胎儿 三尖瓣闭锁不全 

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