M型超声心动图引导定量中晚孕正常胎儿心轴变化规律的研究  

Quantitative Study of Cardiac Axis in Second and Late Trimesters Guided By M-mode Echocardiography

作　　者：谭乳燕 赵博文[1,2] 张金双[1,2] 彭晓慧 王蓓[1,2] 潘美 陈冉[1,2] Tan Ruyan;Zhao Bowen;Zhang Jinshuang;Peng Xiaohui;Wang Bei;Pan Mei;Chen Ran(Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine,Technical Guidance Center for Fetal Echocardiography of Zhejiang Province&Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,浙江省胎儿心脏超声诊断技术指导中心,浙江大学邵逸夫临床医学研究所,杭州市310016 [2]浙江省绍兴市妇幼保健院超声科

出　　处：《中国超声医学杂志》2020年第12期1112-1115,共4页Chinese Journal of Ultrasound in Medicine

基　　金：浙江省基础公益研究计划项目(No.LGF18H180004);浙江省教育厅一般科研项目(No.Y201738828);浙江省中医药科学研究基金项目(No.2018ZB075)。

摘　　要：目的探讨M型超声心动图引导下心轴(CA)测定在正常胎儿心动周期中的变化规律。方法选取在我院行胎儿超声心动图检查的322例孕妇,平均孕龄(27.78±3.84)周,在胎儿心脏四腔心观基础上,运用M型超声心动图引导测定胎儿收缩期心轴(CAS)和舒张期心轴(CAD),并从多切面观察胎儿心内结构,以排除胎儿是否存在心血管畸形。分析心轴与双顶径(BPD)、股骨长(FL)、胸腔面积(TA)、心脏面积(HA)等反映胎儿心血管系统及胎儿整体生长发育的基本参数的关系。结果208例确定为心脏结构及节律正常胎儿,CAD为(35.26±9.20)°,CAS为(41.49±10.31)°,其中190例CAS大于CAD,18例CAS小于CAD;根据国际妇产科超声学会(ISUOG)实践指南标准:健康胎儿CA正常参考范围为(45±20)°,定义<25°和(或)>65°为胎儿CA异常,心轴左偏2例(心轴角度>65°),无心轴右偏;且研究结果表明不同心动周期CA的大小与孕周等反映胎儿生长发育的参数指标无明显相关性。结论应用M型超声心动图指导准确定量胎儿CA,结果显示多数正常胎儿心轴在收缩期大于舒张期,因此采用胎儿心轴筛查胎儿先天性心脏病时应在收缩期测量。Objective To investigate changes in the cardiac axis(CA)shifts within the cardiac cycle of normal fetuses with the M-mode echocardiographic guidance.Methods A total of 322fetuses underwent fetal echocardiography from were enrolled.The average gestational age was(27.78±3.84)weeks.The fetal CA was measured on fetal fourchamber view guided by M-mode echocardiography.The systolic and diastolic phases of the heart were determined by M-mode echocardiographic curves,and the fetal intracardiac structures from multiple sections were carefully assessed to rule out fetal cardiovascular malformations.The fetal intracardiac structure was observed from multiple sections to exclude the presence of cardiovascular malformations in the fetus.Analyze the relationship between CA and biparietal diameter(BPD),femur length(FL),chest area(TA),and heart area(HA),which reflect the basic parameters of fetal cardiovascular system and fetal growth and development.Results 208cases were found with normal fetal cardiac structures and rhythms,and both diastolic CA(CAD)and systolic CA(CAS)were successfully obtained in those 208 fetuses.The CAD range was 17.2°-71.7°,the average CAD was(35.26±9.20)°,and the CAS range was 23°-73.5°,the average CAS was(41.49±10.31)°.The CAS and CAD were different,of which 190cases had CAS greater than CAD,18cases had CAS smaller than CAD.According to the practice guideline of the International Society of Ultrasound in Obstetrics and Gynecology(ISUOG):The normal reference rang for normal fetal CA was(45±20)°,with a CA<25°and/or>65°defined as abnormal fetal CS.2cases had an abnormal leftward shift(the cardiac axis was greater than 65°),and no fetus had right shifted CA.There was no significant correlation between fetal CA and the parameters that reflecting fetal cardiovascular and general growths and development.Conclusions Accurately quantifying fetal CA is realized by using M-mode echocardiography.Fetal CA has demonstrated a shift during the car-diac cycle,with a more leftward shift occurring in systole

关 键 词：M型超声心动图 心轴 定量 

分 类 号：R714.5[医药卫生—妇产科学]