应用多普勒超声心动图测定糖尿病孕妇胎儿心功能的研究

Doppler Echocardiographic Studies on Fetal Cardiac Function of Diabetic Mothers

目的研究糖尿病孕妇胎儿的心功能变化。方法应用多普勒超声心动图测定２３例妊娠期糖尿病孕妇胎儿（糖尿病孕妇胎儿组）和５４例正常胎儿（正常胎儿组）心脏的解剖数值：室间隔厚度（ＩＶＳ）、主动脉（ＡＯ）、肺动脉（ＰＡ）、二尖瓣（ＭＶ）、三尖瓣（ＴＶ）的直径，并测定主、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）、心脏收缩功能参数（ＦｏｒｃｅＦ）。测定二、三尖瓣血流舒张早期峰值流速（ＰＦＶｅ）、舒张晚期峰值流速（ＰＦＶａ）、平均速度（Ｖ）、表示舒张功能的参数。结果糖尿病孕妇胎儿组与正常胎儿组相比，ＩＶＳ明显增厚，ＡＯ、ＰＡ、ＭＶ、ＴＶ直径均增大。主、肺动脉血流的ＰＦＶ、ＳＶ、ＦｏｒｃｅＦ均增加，ＡＣＴ无明显变化。二、三尖瓣的ＰＦＶａ明显增加、二、三尖瓣血流舒张早期峰值流速及舒张晚期峰值流速比值（Ｅ／Ａ）明显下降。结论糖尿病孕妇的胎儿体重、心脏相对较大，心脏收缩力增强，心输出量增加。ＩＶＳ的明显增厚使舒张功能受到影响。

Objective To assess fetal cardiac function by Doppler echocardiography in diabetic pregnancies. Methods We investigated the changes of cardiac function in 54 normal fetuses and 23 fetuses of diabetic mothers. Cardiac anatomic datas were obtained by measuring the diameter of the aortic (AO), the pulmonary artery (PA), the mitral valve(MV), the tricuspid valve (TV) and interventricular septal thickness (IVS). Blood flow evlocity were obtained from the AO, PA, atrioventricular valves. The following variables were measured: peak flow velocity (PFV), accelerate time (ACT), systolic volume (SV) and ForceF. These indices respresented the systolic function. The peak early flow velocity (PFVe), peak late flow velocity (PFVa), PFVe/PFVa(E/A), mean velocity () of MV or TV respresented the diastolic function. Results The results revealed that in fetuses of diabetic mothers, IVS became thickness. The diameter of AO, PA, MV, TV were wider than that of normal fetases. The PFV, SV, ForceF of AO or PA increased significantly. There was no different in ACT between two groups. The PFVa of MV or TV increased significantly, whereas the E/A of both atrioventricular valves decreased. Conclusion It showed that the fetal hyperinsulinemia triggered by maternal hyperglycemia result in fetal weight increasing, as well as hyperplasia and hypertrophy of myocardial cells. An iacreased contractility is compatible with relatively larger size of such fetuses. The intracardiac flow volume increased secondary to the more needs of fetal development. Abnormal thickenning IVS might impair ventricular diastolic function.