超声检测三尖瓣环收缩期位移评估胎儿右室收缩功能的研究

Ultrasonic testing of tricuspid annular plane systolic excursion to evaluate right ventricular systolic function

目的探讨胎儿三尖瓣环收缩期位移（f-TAPSE）在正常胎儿右室收缩功能研究中的价值。方法 2013年12月~2014年3月在四川大学华西第二医院行胎儿超声心动图检查的154例正常中、晚孕孕妇,依孕周（GA）分为3组,分别测量f-TAPSE;收缩期峰值速度（S′）;右心室舒张末期面积（RVEDA）、右心室收缩末期面积（RVESA）,依公式计算右心室面积变化分数（RVFAC）。应用IBM-SPSS19.0统计软件对数据进行分析。结果 f-TAPSE随GA增加而增长,两者间有显著正相关关系（P〈0.001,r=0.81）,f-TAPSE与胎心率间无相关性（P〉0.05）。f-TAPSE与S′、RVFAC间呈正相关关系（P〈0.001,r值分别为0.45、0.38）。各组间f-TAPSE值与GA呈正相关关系（P〈0.001）,各组间差异有统计学意义（P〈0.05）。重复性分析显示操作者内及操作者间差异小,相关性较好。结论 M型超声心动图测量f-TAPSE,可操作性强,可重复性好,对评估胎儿右室收缩功能具有较好的临床参考价值。

Objective To investigate the value of fetal tricuspid annular plane systolic excursion（f-TAPSE）in evaluating normal fetal right ventricular systolic function.Methods Between December 2013 and March 2014,154 pregnant women in second and third trimester underwent fetal echocardiography in our hospital were recruited in the present study.They were divided into three groups according to the gestational age.M-mode echocardiography was applied to obtain the longitudinal excursion f-TAPSE.Tissue Doppler imaging（TDI）was applied to obtain the dynamic spectrum of tricuspid annular and then the tricuspid annular peak systolic velocity（S′）was measured.The two-dimensional echocardiography was used to measure the RVEDA、RVESA and calculate the RVFAC.Using the IBM-SPSS19.0statistical software,the correlations between f-TAPSE and GA,S′and RVFAC were determined by Pearson correlation analysis,and differences between different groups were determined by the analysis of variance.A 2-tailed p value0.05 was chosen as the level of significance.Results The f-TAPSE increased with the GA and showed a significant positive correlation to the GA（P〈0.001,r=0.81）,while there was not a significant correlation between f-TAPSE and fetal heart rate（P〈0.05）.The f-TAPSE was positively correlated to S′and RVFAC（P〈0.001,r=0.45,0.38,respectively）.There were significant differences for the f-TAPSE between different groups（P〈0.001）.Repeatability analysis shows the tiny difference between experiments of one operator,and the excellent correlation among operators as well.Conclusion The measurement of f-TAPSE with M-mode echocardiography is well operable and repeatable.The f-TAPSE has a significant value in evaluating normal fetal right ventricular systolic function.