彩色多普勒检测胎心三尖瓣返流的临床价值

Clinical value of color Doppler detection of fetal heart tricuspid regurgitation

目的研究胎心三尖瓣返流的原因及临床价值。方法应用彩色多普勒对934例胎儿进行产前系统筛查及多普勒超声心动图检查，57例孕周为20-38周胎心探及三尖瓣返流，超声观察胎心结构、返流信号分布、测量最大返流速度并加以分析。结果在934例中有57例胎儿出现三尖瓣返流，发生率为6．1％（57／934）。在57例胎心三尖瓣返流病例中，非先心病组46例，先心病组11例，先心病组超声显示心内结构异常。无心内结构异常的三尖瓣返流速度与心内结构异常的三尖瓣返流速度比较无显著性差异（χ^2=8．539，P〉0．05）。结论当检出三尖瓣返流时，应进一步追踪扫查心内结构有无畸形，在排除先心病之后即应提示心脏负荷增加，若伴有右心扩大是发生心力衰竭的依据。

Objective To study the causes and clinical value of fetal tricuspid regurgitation. Methods Among 934 cases with prenatal screening and Doppler echocardiography, 57 cases of gestational age 20-38 weeks were found with tricuspid regurgitation. Uhrasonography was performed to observe fetal heart structure and regurgitation signal distribution, and to measure the maximum reflux rate. Results There were 57 cases with fetal tricuspid regurgitation, and the incidence was 6.1% （57/934）. Forty-six cases were in non-congenital heart disease group, and 11 cases in congenital heart disease group. In congenital heart disease group ultrasound examination indicated structural abnormalities of the heart. There was no significant difference in tricuspid regurgitation speed between cases with cardiac structural abnormalities and those without （χ^2= 8. 539, P 〉 0.05）. Conclusion When tricuspid regurgitation is detected, further examination should be done to ensure whether structural abnormality exists. If congenital heart disease is excluded, tricuspid regurgitation indicates increased heart load. Associated with cardiac failure is the basis of right ventricular enlargement.