应用Tei指数评估胎儿整体心室功能的临床研究

The Clinical study on the application of Tei index in the evaluation of fetal heart function

目的:应用脉冲多普勒测量不同组别胎儿的Tei指数,评估临床应用价值。方法:选取120例正常胎儿,根据孕周分为24~29^(+6)孕周组(n=40)、30~35^(+6)孕周组(n=40)、36~41^(+6)孕周组(n=40);185例病理胎儿:妊高征胎儿组100例,其中妊娠期高血压38例,轻度子痫前期30例,重度子痫前期例32例;妊娠期糖尿病胎儿85例,其中血糖控制良好45例,血糖控制不良40例。测量左、右心室Tei指数。结果:妊娠晚期正常胎儿左心室平均Tei指数为0.41±0.17,右心室为0.41±0.16,Tei指数与孕周无关。重度子痫前期组、妊娠期糖尿病血糖控制不良组胎儿左、右心室Tei指数(0.50±0.15、0.54±0.13;0.50±0.17、0.50±0.10)均高于正常组(0.41±0.17、0.41±0.16),差异有统计学意义(P<0.05)。结论:中晚期正常妊娠胎儿Tei指数不受孕龄的影响。重度子痫前期胎儿、妊娠期糖尿病血糖控制不良胎儿左、右心室Tei指数均显著高于正常组。Tei指数可有效评估胎儿心室功能。

Objective Toinvestigate the fetal Tel index by pulsed Doppler and to establish the range of the fetal Tel index in the middle and the late normal pregnancy, and to evaluate the clinical application of Tel index. Methods One hundred and twenty normal fetuses whose gestational weeks varying from 16 to 40 were divided into the 24 - 29^＋6 gestational age group, the 30 - 35^ ＋6 gestational age group and the 36 - 41 ^＋6 gestational age group. According to the disease, 185 pathologic fetuses were divided into the PIH group （38 cases of gestational hypertension, 30 cases of mild preeclampsia, 32 cases of severe preeclampsia）, the gestational diabetes group （45 cases of good glycemic control, 40 cases of poor glyeemic control）.The isovolumic contraction time ＋ isovolumic relaxation time（ICT＋IRT）, ejection time （ET） were measured and the Tel index was calculated by the formula Tel = （ICT＋IRT）/ET in 305 cases. Results The mean Tel index in the normal fetuses was as follows： the left ventricular （LV） Tel and the right ventricular （RV） Tel was 0.41 ± 0.17,0.41 ± 0.16, respectively. No significant changes of LV and RV Tel index were observed in the normal fetuses with increasing gestational week （F = 1.17,P = 0.32;F = 0.77,P = 0.47）. The LV and RV tel index in the severe preeclampsia group and in the poor glycemic control group （0.46 ± 0.10,0.47 ± 0.15;0.50 ± 0.15,0.53 ± 0.13; 0.50 ± 0.17,0.50 ±0.10） were higher than those in the normal group（0.41 ±0.17,0.41 ± 0.16）, with significant differences（P 〈 0.05）. Conclusions The Tel index is stable and not influenced by the pregnant week in the middle and the late pregnancy. The Tel index may be a convenient, reliable and useful tool to measure fetuses with cardiac insufficiency.