临床研究 多普勒超声检测胎儿心脏机械性PR间期的临床意义研究王鸿 耿丹明 李慧忠 涂学军 王玉新 张燕萍摘要! 目的 应用多普勒超声技术测量胎儿心脏机械性PR间期并探讨其临床意义。
方法 选取经胎儿超声心动图检出的83例疾病组胎儿,分别为先天性心脏病及心律失常。
正常对照组为100例中、晚孕胎儿。
应用彩色多普勒引导脉冲多普勒取样容积记录左心室流入道及流出道血流频谱,测量从舒张期二尖瓣A峰起始至收缩期主动脉射血起始的心房到心室的传导时间(PR间期),并同时测量收缩期主动脉射血起始至二尖瓣A峰起始的时间(VA间期)。
结果 83例疾病组胎儿中先天性心脏病69例,心律失常12例,双胎输血综合征1例(双胎儿)。
其中54例多普勒超声测量PR间期延长(131~220m s),并检出自身免疫性抗体阳性和弱阳性5例。
正常对照组100例的中、晚孕孕妇均无自身免疫系统疾病,并经超声排除胎儿先天性心脏病、心律失常及其他胎儿异常,多普勒超声测量PR间期值均∀130m s。
两组PR间期、VA间期比较差异有统计学意义(P< 0.01)。
结论 本研究结果表明,除孕妇患自身免疫性疾病可引起胎儿传导系统受损外,胎儿患先天性心脏病、心律失常等疾病时,其窦房结、房室结传导功能的易损性明显高于正常胎儿。
其影响因素与心脏解剖结构异常和传导系统发育不良的相关性有待进一步研究。
关键词! 多普勒超声检查;PR间期;胎儿心脏C li nical application ofm echanical PR i nterval of Doppler ultrasound i n fetal car diac WANG H ong,GEN GD an m ing,LI H ui zhong,Tu Xue jun,WA N G Yu x in, ZHANG Yan p i ng.D epart m ent of U ltrasound,Fuzhou General H ospoit al of N anji ng U ilitary Co mnand,PLA,Fuzhou350025,ChinaAbstract! Objective To explore the app licati on of m echan i cal PR i nterva l of D opp ler ultrasound m easure m ent i n fetal hear,t and to anal yze the test results and t he cli n i ca l si gn ifi cance of a group of abnor m al fet uses.M ethods A total of83cases of abnor m al group detected by feta l echocard i ography were classifi ed as congenita l heart disease and arrhyt h m i a.The healthy contro l group consi sted of100cases i n m ed i u m ter m and late gestation.The pu l se D oppler sa m ple vo l u m e gu i ded by col or D opp ler recorded t he blood fl o w spectru m of left ventri cular i n fl o w tract/outflo w tract 基金项目:福建省科技重点课题基金[2009I0021];南京军区面上课题2007[07M092]作者单位:350025 福州,南京军区福州总医院超声科and m easured t he conduction ti m e fro m t he beg i nni ng o f t he d i asto li c m itral A peak to t he begi nn i ng o f aortic systo li c ejecti on(PR i nterval)and fro m the beg i nn i n g of aorti c systo li c e j ecti on to the beg i n n i ng of m itral A peak(VA i nterval).Results The ei ghty t hree cases o f abnor m al group(69cases of congen ital heart disease and12cases of arrhy t h m i a)i n cl uded54cases o f D oppler u ltrasound m easure m ent of PR i nterva l pro l ongation(131 220m s).One hundred cases of nor m a l contro l group had no auto i m m une disease,wh i ch w as ruled out by u ltrasound of fetal congen ital heart disease, arrhyt h m i a and other fetal ano m ali es,whose D opp l er ultrasound m easure m ent o f P R i nterval va l ue was no t less t han130m s.The co m parison PR i nterval versus VA i nterval had t hem ost si gnifi cant d i scri m i nati ng power(P﹤0.01).Conclusi on The resu lts of t h is st udy showed t he pregnant wo m en sufferi ng fro m auto i m mune d iseases can lead to da m age of fetal conducti on syste m.In add ition,the vu l nerability of si nus node and atri oven tri cular node i n the fetuses of congenital heart disease,arrhyt h m i a was si gn ifi cantl y h i gher t han nor m a l group.The relevance bet w een t heir pathogen i c fact ors w ith abnor m al anato m ical structure o f t he cardiac dysp l asia conducti on syste m shou l d be further st ud i ed.K ey w ords! D opp ler ultrasonography;PR i nterva;l Fetal heart近年来随着胎儿超声心动图的应用发展,产前超声心动图检查可诊断胎儿各种心律失常;特别是对紊乱、快速型心律失常的诊断,超声心动图检查已成为常规可靠的检测手段。
