三种多普勒超声检查方法在定量测定胎儿心脏房室传导时间的应用  

Application of three Doppler methods in quantitative measurement of fetal atrioventricular conduction time

作　　者：潘美[1] 赵博文[1] 毛彦恺[1] 彭晓慧[1] 杨园[1] 王蓓[1] 孙晓露[1] 吴俊[2] Pan Mei;Zhao Bowen;Mao Yankai;Peng Xiaohui;Yang Yuan;Wang Bei;Sun Xiaolu;Wu Jun(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;Department of Ultrasound,the Affiliated Hospital of Hangzhou Normal University,Hanghzou 310000,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310016 [2]杭州师范大学附属医院超声科,310000

出　　处：《中华医学超声杂志（电子版）》2021年第7期681-687,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：浙江省基础公益研究计划项目(LGF18H180004,LGF20H180013)。

摘　　要：目的采用3种多普勒超声检查方法:上腔静脉/升主动脉脉冲多普勒同步记录法(SVC/AAO)、二尖瓣环组织多普勒法(TDI)及肺动/静脉脉冲多普勒同步记录法(PA/PV)分别创建中晚孕期胎儿心脏房室传导时间(AV)正常值参考范围,并分析AV值与孕周、胎儿心率及心脏面积的相关性。方法选取2019年6月至12月在浙江大学医学院附属邵逸夫医院接受胎儿超声心动图检查的正常胎儿227例入选本研究,孕周为16~41周,根据孕周分为5组,采用SVC/AAO法、TDI法及PA/PV法分别测量AV值,分析3种方法的测量成功率;并获得不同孕周组AV值的正常范围;采用单因素方差分析及多重比较(LSD-t法)对不同方法获得AV值的差异进行分析,对AV值与孕周、胎儿心率及胎儿心脏面积之间进行Pearson相关分析;采用组内相关系数(ICC)评估每种方法检查者内和检查者间重复性。结果3种方法均取得了较高的测量成功率,SVC/AAO法为94.58%;TDI法为100%;PA/PV法为95.83%;测得AV值正常范围:AV-SVC/AAO为(115.94±6.67)ms;AV-TDI为(117.69±6.43)ms;AV-PA/PV为(123.70±6.42)ms,AV-PA/PV最大,AV-SVC/AAO最小,两两比较差异均具有统计学意义(t=-2.843、-12.662、-9.819,P=0.005、<0.001、<0.001);所有AV值与孕周均呈正相关(r=0.677~0.680,P<0.001),与胎儿心脏面积均呈正相关(r=0.648~0.654,P<0.001),与胎儿心率均呈负相关(r=-0.568~-0.581,P<0.001)。观察者内及观察者间重复性检验显示3种多普勒超声检查方法测量的重复性均良好(ICC均>0.80)。结论3种多普勒超声检查方法用于测量胎儿心脏AV可行且重复性好;中晚孕期正常胎儿AV值受孕周、胎儿心脏面积及胎儿心率影响,且不同方法所测得AV值存在差异;因此,应选择一种合适的方法测量胎儿心脏AV,同时,需要认识到不同的方法所得测量值之间的差异性,这在临床工作中具有重要意义。Objective To establish the normal range of fetal atrioventricular(AV)time intervals during the second and third trimesters assessed by three different pulsed-wave Doppler techniques[superior vena cava and ascending aorta(SVC/AAO)method,tissue Doppler imaging(TDI),and pulmonary artery and pulmonary vein(PA/PV)method and analyze the correlation of AV value with gestational age,fetal heart rate,and heart area.Methods From June to December 2019,227 normal fetuses who underwent echocardiography at the Sir Run Run Shaw Hospital of Zhejiang University College of Medicine were selected.The gestational age was 16 to 41 weeks.They were divided into five groups according to gestational age.Pulsed-wave Doppler methods including SVC/AAO,TDI,and PA/PV were applied to measure AV,respectively.The measurement success rate and the normal range of AV values in different gestational weeks were obtained.Single-factor analysis of variance and multiple comparisons(LSD-t method)were used to analyze the differences in AV values obtained by different methods.Pearson correlation analysis was performed to examine the correlation of AV values with gestational age,fetal heart rate,and fetal heart area.Intraclass correlation coefficient(ICC)was used to evaluate the in-observer and inter-observer repeatability of each method.Results All the three Doppler methods achieved a high measurement success rate:SVC/AAO,94.58%;TDI,100%;PA/PV,95.83%.The normal range of AV values was:AV-SVC/AAO,(115.94±6.67)ms;AV-TDI,(117.69±6.43)ms;AV-PA/PV,(123.70±6.42)ms;the difference between them was statistically significant(t=-2.843,-12.662,-9.819;P=0.005,<0.001,<0.001).All AV values were positively correlated with gestational age(r=0.677~0.680,P<0.001)and fetal heart area(r=0.648~0.654,P<0.001),but negatively correlated with fetal heart rate(r=-0.568~-0.581,P<0.001).In-observer and interobserver repeatability tests showed that the three Doppler methods had good repeatability(ICC>0.80).Conclusion All the three Doppler methods are feasible and reproducible in meas

关 键 词：胎儿超声心动图 房室传导时间 房室传导阻滞 产前诊断 

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]