妊娠高血压综合征孕妇胎儿心肌力学变化特点的二维超声斑点追踪显像研究

Assessment ventricular mechanics changes of fetuses in pregnancy induced hypertension syndrome by two-dimensional speckle tracking imaging

目的探讨妊娠高血压综合征孕妇胎儿心肌力学变化的规律与特点及二维超声斑点追踪技术的作用。方法选取新疆医科大学第五附属医院就诊的妊娠32~36 w健康孕妇50例作为对照组,选取孕周32~36 w、血压≥140/90 mm Hg的孕妇50例作为妊娠高血压综合征组,选取孕周32~36 w、血压≥160/110 mm Hg、尿蛋白≥300mg/24 h或（＋＋）的孕妇作为妊娠子痫前期组。使用心脏超声探头,常规测量胎儿心室腔大小、室壁厚度及心功能,采集并储存心尖四腔切面;使用2D-STI分别测量各组胎儿室间隔、左室侧壁基底段、中间段及心尖段心肌纵向应变率（longitudinal strain rate,SLR）、收缩期峰值（SLR-S）及舒张期峰值（SLR-A）。结果 （1）与对照组比较,妊娠高血压综合征及妊娠子痫前期组胎儿室间隔及左室侧壁舒张末期室壁增厚,差异有统计学意义（P〈0.05）,妊娠子痫前期组较妊娠高血压综合征组明显增厚（P〈0.05）。（2）与对照组比较,妊娠高血压综合征组及子痫前期组胎儿室间隔、左室侧壁基底段、中间段及心尖段心肌纵向应变率SLR-S及SLR-A均降低,差异有统计学意义（P〈0.05）,妊娠子痫前期组较妊娠高血压综合征组明显降低（P〈0.05）。结论妊娠高血压可造成胎儿心肌功能损害,二维超声斑点追踪技术可作为检测妊高症孕妇胎儿心肌力学变化的重要方法。

Objective To study the ventricular mechanics changes of fetuses using two-dimensional speckle tracking imaging in pregnancy induced hypertension syndrome. Methods We chose 50 healthy pregnant women＇s cases in our hospital as control group,they were 32-36 weeks of gestation,the other two groups were hypertensive disorders in pregnancy（ PIH） group（ 50 cases,32- 36 weeks of gestation,BP ≥140 /90 mm Hg） and preeclampsia group [32-36 weeks of gestation,BP≥160 /110 mm Hg,PRO≥300 mg /24 h（ ＋＋） ]. Each group should exclude congenital malformation,we measured ventricular cavity,RVWT and cardiac function of the fetal,collect and save apical four chamber view,2D-STI was used to measure the strain rate SLR-S and SLR-A of the interventricular septum（ IVS）,left ventricular lateral wall（ LVLW） at basal and middle and tip segment of each group. Results（ 1） Compared with the control group,the IVS and LVLW of PIH group and pre-eclampsia group were thicker,there were statistical significance between them（ P〈0. 05）,pre-eclampsia group was more thicker than that in PIH group,the differences were statistical significance（ P〈0. 05）.（ 2） Compared with control group,the SLR-S and SLR-A of the IVS and LVLW at basal and middle and tip segment were all reduced in PIH group and preeclampsia group,there were significant differences between them（ P〈0. 05）,pre-eclampsia group was more decrease than that of PIH group,there were significant differences between them（ P〈0. 05）. Conclusion Hypertensive disorders in pregnancy would lead to myocardium damage of the fetal,2-dimensional speckle-tracking technique could be significant method to measure the myocardium mechanics change of PIH pregnant woman＇s fetal.