超声检查宫内生长受限胎儿心功能的临床研究

Research on cardiac function in fetuses with intrauterine growth restriction

目的使用Tei指数和射血分数(EF)研究宫内生长受限(IUGR)胎儿心功能。方法选取IUGR胎儿42例,分为脐血流正常组(24例)和脐血流异常组(18例),正常对照组选取50例正常胎儿,测量Tei指数和EF。41例IUGR胎儿出生后随访心功能。结果 1脐血流正常组胎儿左室Tei指数高于正常对照组(P<0.01),右室Tei指数与正常对照组比较差异无统计学意义(P=0.142),脐血流异常组胎儿左、右室Tei指数均高于正常对照组(P<0.01);2IUGR胎儿EF与正常对照组比较差异无统计学意义;3产后随访示17例脐血流异常组胎儿中,12例左、右室EF均<60%,1例右室<60%,4例左、右室EF均>60%;24例脐血流正常组胎儿左、右室EF均>60%。结论 IUGR胎儿存在心功能损害,严重者产后心功能未能恢复正常。Tei指数评价IUGR胎儿心功能受损早于EF,对EF正常而Tei指数高的IUGR胎儿,应密切监测,选择适当时机终止妊娠,改善围产儿结局。

Objective To evaluate the cardiac function of intrauterine growth restriction（IUGR） fetuses with Tei index and eject fraction（EF）.Methods According to the umbilical artery blood flow,42 IUGR fetuses were divided into normal group（24 cases） and abnormal group（18 cases）.Fifty normal fetuses were included in normal control group.Tei index and EF were measured in all groups.The postnatal cardiac function was followed up in 41 IUGR fetuses.Results 1 Left ventricular（LV） Tei index in IUGR normal umbilical blood flow group was higher than that in normal control group（P〈0.01）.There was no statistical difference of right ventricular（RV） Tei index in normal umbilical blood flow group and normal control group（P =0.142）.LV and RV Tei index in abnormal umbilical blood flow group were significantly higher than those in normal control group（P〈0.01）.2There was no statistical difference of EF between IUGR group and normal control group.3The cardiac function of IUGR fetuses were followed up.In abnormal umbilical blood flow group,both LVEF and RVEF value were less than 60% in 12 cases,RVEF value was less than 60% in 1 case,LVFF and RVEF value were greater than 60% in 4 cases.LVEF and RVEF of 24 cases in normal umbilical blood flow group were all greater than 60%.Conclusion There is cardiac dysfunction in IUGR fetuses,the fetuses who had severe cardiac dysfunction could not return to normal after birth.Evaluating the degree of cardiac dysfunction in IUGR fetuses by Tei index was sooner than EF.Tei index can be used to discover cardiac dysfunction early in IUGR fetuses.IUGR fetuses with normal EF and elevated Tei index should be closely monitored,in order to select the appropriate time to terminate the pregnancy and to improve perinatal outcomes.