超声心动图测定宫内发育迟缓胎儿心功能的研究

Doppler Echocardiographic Studies on the Fetal Cardiac Function in Intrauterine Growth Retardation

目的：研究宫内发育迟缓胎儿的心功能变化。方法：应用多普勒超声心动图测定６４例正常胎儿（正常胎儿组）和３６例ＩＵＧＲ胎儿（ＩＵＧＲ组）主动脉、肺动脉血流的峰速（ＰＦＶ）、平均速度（Ｖ）、加速时间（ＡＣＴ）、每搏输出量（ＳＶ）、心输出量（ＣＯ），以此表示心脏收缩功能的参数。测定二、三尖瓣血流的舒张早期峰值流速（ＰＦＶｅ）、舒张晚期峰值流速（ＰＦＶａ）、Ｅ／Ａ、Ｖ表示舒张功能的参数。结果：在正常胎儿组中，主动脉的ＰＦＶ、Ｖ、ＡＣＴ均大于肺动脉，而左心室的ＳＶ、左心室输出量（ＬＣＯ）、均小于右心室。二尖瓣的ＰＦＶｅ、ＰＦＶａ、均小于三尖瓣。ＩＵＧＲ组与正常胎儿组比较，主、肺动脉的ＰＦＶ、Ｖ、ＳＶＣＯ、均明显下降，肺动脉的ＡＣＴ明显减少，主动脉的ＡＣＴ明显增加，左心室ＳＶ、ＬＣＯ、均大于右心室。二尖瓣及三尖瓣的Ｅ／Ａ明显下降，三尖瓣的ＰＦＶｅ、ＰＦＶａ、Ｖ明显下降，二尖瓣的ＰＦＶｅ、ＰＦＶａ均大于三尖瓣。结论：在ＩＵＧＲ胎儿中可能发生“脑微效应”，即胎儿缺氧后，出现血流灌注再分布。

Objective: To assess fetal cardiac function by Doppler echocardiography in intrauterine growth retardation (IUGR). Methods: We investigated the changes in cardiac function in 64 normal fetuses and 36 fetuses with IUGR. Blood flow velocity waveforms were obtained from the aorta, pulmonary artery and atrioventricular valves. The following variables were measured: peak flow velocity (PFV), mean velocity (), accelerate time (ACT), systolic volume (SV) and cardiac output (CO) represented the systolic function; the peak early flow velocity (PFVe), peak late flow velocity (PFVa), PFVe/PFVa (E/A), mean velocity () of mitral or tricuspid valve represented the diastolic function. Results: In normal fetuses, the PFV,,ACT of aorta were all greater than those of pulmonary artery, whereas SV, CO in left ventricle were smaller. The PFVe, PFVa in mitral valve were smaller than those of tricuspid valve. In IUGR fetuses, the PFV, , SV, CO of aorta or pulmonary artery were significantly lower than those of normal. The ACT in pulmonary artery decreased significantly, but increased in aortic artery. The SV, Co of left ventricle were greater than those of right ventricle. The E/A of mitral and tricuspid valve, PFVe, PFVa, of tricuspid valve were all decreased. The PFVe, PFVa in mitral valve were greater than those of tricuspid valve. Conclusions: The changes of cardiac function in IUGR are probably caused by “brain sparing”, which means a redistribution of cardiac flow after hypoxia.