先心病胎儿临床特征及超声在其脑血流动力学检测中的应用

Application of Clinical Features of Fetus with Congenital Heart Disease and Ultrasonic in the Detection of Cerebral Hemodynamics

目的研究先心病(CHD)胎儿临床特征,并探讨超声在其脑血流动力学检测中的应用价值。方法收集我院2013年5月~2015年8月期间经超声心动图等手段确诊为CHD胎儿的64例孕妇(记为观察组),分析CHD胎儿的临床相关特征。选取同期50例胎检无异常的孕妇(记为对照组),采用脉冲多普勒超声技术对2组胎儿进行大脑中动脉(MCA)、脐动脉(UA)的血流动力参数[搏动指数(PI)、脑/脐血管阻力指数比值(CPR)]检测并比较二者差异;选取同时期30例确诊为CHD患儿(记为CHD组)和来院体检的健康小儿30例(记为正常组),行常规凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、纤维蛋白原含量(Fbg)、抗凝血酶(AT)活性]检测并比较二者差异。结果 (1)CHD胎儿存在下列临床特征:胎儿男性高、母体多存在环境暴露因素、心脏多发畸形率较高,心脏畸形类型以大血管转位较为常见等,单项目内环比相较比重偏高,差异显著(P<0.05)。(2)经脉冲多普勒超声检测血流频谱,观察组、对照组MCA—PI相较无显著差异(P>0.05);但观察组UA—PI(1.42±0.12)较对照组(1.20±0.14)高,CPR(1.35±0.13)较对照组(1.63±0.09)低,均差异显著(P<0.05)。(3)凝血指标检测显示CHD组PT、APTT、AT活性偏低、Fbg偏高,均差异显著(P<0.05)。结论 CHD胎儿具有男性发病率高、受母体环境暴露影响较大等明显临床特征;凝血功能呈高凝状态;通过脉冲多普勒超声技术能方便检测出CHD胎儿脑血管阻力下降的血流动力学特征。为临床早期诊断CHD胎儿提供有效手段。

Objective To study clinical features of fetus with congenital heart disease （CHD）, to explore the application value of ultrasonic in the detection of cerebral hemodynamics. Methods 64 cases of pregnant women with CHD fetuses diagnosed by echocardiography in our hospital from May 2013 to August 2015 were marked as the observation group, after obtaining the consent of the hospital ethics committee and these parents, clinical related features of CHD fetuses were analyzed. 50 cases of pregnant women without abnormal in fetus examination in the same period were marked as the control group, pulsed wave Doppler echocardiograpdy was used to detect hemodynamics parameters of middle cerebral artery（MCA） and umbilical artery （UA） I pulsatility index （ PI）, brain/umbilical vascular resistance index ratio （CPR） J in the two groups, the differences between the two groups were compared ;30 cases diagnosed as CHD in children （marked as the CHD group） ,30 cases of healthy children （marked as the normal group） in the same period were selected, routine coagulation function indexes [ prothrombin time （ PT）, activated partial thromboplastin time （ aPTT）, fibrinogen（Fbg） and antithrombin （AT）activity] were detected, the differences between the two groups were compared. Results ①CHD fetuses have the following clinical features： high proportion of fetal male, environmental exposure factors in maternal, high cardiac multiple malformations rate, transposition of the greatvessels was more common in cardiac malformations, internal comparison was significantly higher than internal ratio in the single project（P 〈 0. 05 ）. ②Pulsed wave Doppler echocardiograpdy was used to detect blood flow spectrum,there was no significant difference in MCA-PI between the observation group and the control group （P 〉 0. 05 ） ;but UA-PI in the observation group（ 1.42 ± 0. 12 ）was significantly higher than the control group （ 1.20 ±0. 14 ）, CPR（ 1.35±0. 13 ） was significantly lower than the control group （ 1.63± 0. 09 ） （ P 〈 0. 05 ）. ③Coagulation indexes detection showed that CHD group of PT, aPTT, activity AT low, Fbg high, （ P 〈 0. 05 ）. Conclusion High incidence of CHD with male fetus, are greatly influenced by maternal environmental exposure, such as obvious clinical features;The function of blood coagulation is high coagulation state;By pulse doppler ultrasound can detect CHD fetal cerebral vascular hemodynamic characteristics of the resistance decreased. Provide effective means for clinical early diagnosis of CHD fetal.