先天性心脏病胎儿脑血流动力学变化的临床研究

Clinical study of cerebrovascular blood flow dynamics in fetus with congenital heart disease

目的探讨先天性心脏病（CHD）对胎儿脑血流动力学的影响，及不同类型CHD对脑血流动力学的影响程度。方法正常胎儿200例和产前超声心动图诊断为CHD胎儿159例，其中左心发育不良综合征（HLHS）23例，左心梗阻性病变（LSOL）19例，右心发育不良综合征（HRHS）15例，右心梗阻性病变（RSOL）33例，间隔缺损36例，圆锥动脉干畸形（CTD）33例。测量胎儿大脑中动脉搏动指数（MCA—PI）、脐动脉搏动指数（UA—PI）及脑／脐血管PI比值（CPR）。结果HLHS、HRHS、RSOL、CTD及SD组胎儿的MCA—PI和CPR均较对照组减低，UA—PI均较对照组升高，差异均有统计学意义（P〈0．05）；LSOL组的各参数与对照组比较差异均无统计学意义（P〉0．05）。结论宫内CHD胎儿出现脑血管阻力下降，不同类型CHD脑血管阻力的改变程度不同，提示不同类型CHD胎儿存在不同程度的脑循环代偿反府。

Objective To determine whether CHD modify cerebrovascular flow dynamics in CHD fetuses,and the influence on different types of CHD. Methods Two hundred normal fetuses and 159 fetuses who were diagnosed CHD by prenatal echocardiogram were studied. CHD fetuses were divided into 6 groups according to hemodynamics ： hypoplastic left heart syndrome （HLHS, n = 23） ,left-sided obstructive lesions （LSOL, n = 19）, hypoplastic right heart syndrome（ H RHS, n = 15）, right sided obstructive lesions （RSOL, n = 33）,septal defect （SD, n = 36）,conotruncal defects（CTD, n = 33）. The pulsatility index（H） and the cerebroplacental Doppler ratio（CPR） of the middle cerebral artery（MCA） and umbilical artery（UA） in normal and CHD group were measured by color Doppler flow system. Results MCA-PI and CPR in HLHS, HRHS,RSOL, CTD and SD groups all decreased compared with normal fetuses （ P 〈0.05）, and UA PI in these groups increased compared with normal fetuses （ P 〈0.05）, whereas none parameters in LSOL changed significantly compared with the control group（ P 〉0. 05）. Conclusions Fetuses with CHD had decreasing cerebrovascular impedance. Different types of CHD had different levels of cerebrovascular impedance, which indicated that different types of CHD induced different levels of cerebrovascular circulation compensation.