超声心动图对糖尿病孕妇胎儿肺静脉血流频谱的动态研究

Prenatal echocardiographic study of fetal pulmonary venous spectra in diabetic pregnancy

目的对糖尿病孕妇胎儿肺静脉血流频谱进行动态观察,并与正常胎儿比较,为糖尿病孕妇胎儿左心室舒张功能评价提供客观依据。方法分别在妊娠20～28周、32～38周,应用胎儿超声心动图观察34例糖尿病孕妇和54例正常孕妇的胎儿心脏结构。探测胎儿肺静脉、二尖瓣血流,测量肺静脉S波(收缩期峰值速度)、D波(舒张期峰值速度)、A谷(心房收缩波速度),二尖瓣E峰速度、A峰速度,并计算肺静脉S/D值及二尖瓣E/A值。结果无论在中孕期或晚孕期,研究组肺静脉血流频谱S/D值、A谷速度与正常对照组比较差异有显著性意义(P<0.05),而常规采用的二尖瓣血流E/A值两组间差别无显著性意义(P>0.05)。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变;胎儿肺静脉血流频谱S/D值、A谷速度较二尖瓣血流E/A值能更敏感地反映胎儿左室舒张功能的变化。

Objective To assess fetal left ventricular diastolic function in diabetic pregnancies by echocardiography. Methods Changes of left ventricular diastolic function in 34 fetuses of diabetic mother and 54 normal fetuses were prospectively studied by detailed fetal echocardiography for two times,respectively at fetus gestational age 20-28 weeks and 32-38 weeks. The parameters of pulmonary venous flow and mitral valve were measured and S/D, E/A were calculated. These variables were then analyzed using an unpaired 2-tailed Student t test. Results Fetal pulmonary venous flow S/D, presystolic velocity in diabetic pregnancies were different from those of control group(P<(0.05)). The E/A of mitral valve had no evident difference between two groups(P>(0.05)). Conclusions The fetuses of diabetic pregnancies demonstrated signs of altered left ventricular diastolic function at both medium and late periods of pregnancy. Fetal pulmonary venous flow S/D, presystolic velocity were more sensitive than mitral valve (E/A) to reflect the variation of fetal left ventricular diastolic function.