胎儿肺动静脉多普勒血流频谱同步记录法测量胎儿心脏传导时间的应用研究

Evaluation of fetal cardiac conduction time by simultaneous recording of Doppler blood flow spectrum of fetal pulmonary artery and vein

目的探讨胎儿肺动静脉多普勒血流频谱同步记录法在定量测量胎儿心脏传导时间中的应用价值。方法选取221例16-41周的正常胎儿，采用脉冲多普勒（PD）法、组织多普勒（DTI）法及肺动静脉同步记录（PA—PV）法分别测量每例胎儿的房室传导时间（AV）和心室开始收缩到下一心动周期心房开始收缩的时间间期（VA），比较三种方法测量的一致性。结果①三种不同测量方法获得的AV、VA值经两两比较差异均无统计学意义（P〉0．05）。②采用PA—PV法测量AV、VA经直线相关分析，AV与孕周呈显著正相关（r=0．825，P=0．000），vA与孕周呈弱相关性（r=0．216，P=0．000）。③AV与心率呈负相关（r=-0．236，P=0．000）；VA与心率呈显著负相关（r=-0．860，P=0．000）。④经直线相关分析，AV与双顶径呈正相关（r=0．188，P=0．005）；VA与双顶径无显著相关性（r=0．054，P=0．428）。⑤比较不同孕周胎儿的AV和VA，经方差分析，各组间AV差异有统计学意义（P=0．014），以〉36周Av最长；vA各组间差异无统计学意义（P=0．941）。⑥按照不同双顶径进行分组，经方差分析，AV各组问差异有统计学意义（P=0．004），以双顶径8～9cm组最长；VA各组间差异无统计学意义（P=0．829）。结论PA—PV法与PD法、DTI法测定胎儿心脏传导时间具有同等临床应用价值，所测得数据可作为临床参考值，对胎儿心律失常的定量分析具有重要应用价值。

Objective To investigate the value of synchronous recording of Doppler blood flow spectrum of fetal pulmonary artery and vein in quantitative measurement of fetal heart conduction time. Methods A total of 221 fetuses aged 16 - 41 weeks were enrolled in this study. Each fetus was measured by pulsed Doppler （PD）, tissue Doppler （DTI） and pulmonary arteriovenous synchrony （PA-PV）. Atrioventricular conduction time （AV） and the time period from ventricular contraction began to shrink to the next cardiac atrial contractions （VA） were recorded for comparing the consistency of three measure methods. Results ①The AV and VA obtained by three different measurement methods have no significant difference after any comparison （ P 〉0.05）. ②）There was a significant positive correlation between AV and gestational age （r = 0. 825, P = 0. 000）. There was a weak correlation between VA and gestational age （r=0.216, P =0.000）. ③AV was negatively related to heart rate （r = -0.236, P =0.000）;VA was negatively related to heart rate （ r = - 0. 860, P = 0. 000）. ④There was a positive correlation between AV and biparietal diameter （ r = 0. 188, P = 0.005）. There was no significant correlation between VA and biparietal diameter （ r = 0. 054, P = 0. 428）.⑤ AV and VA in different gestational weeks fetuses were analyzed by ANOVA. The differences in AV among PD, DTI and PA-PV groups were statisticallysignificant （P = 0.014）, AVe36 weeks was the longest, and there was no significant difference in VA among PD, DTI and PA-PV groups （ P = 0.941 ）. ⑥According to different biparietal diameter grouping, the differences in AV among PD, DTI and PA-PV groups were statistically significant （ P = 0.004）, and biparietal diameter was 8- 9 cm. There was no significant difference in VA among PD, DTI and PA-PV groups （ P = 0.829）. Conclusions PA-PV method, PD method and DTI determination of fetal heart conduction time have the same clinical value, the measured data can be used as a clinical reference value, quantitative analysis of fetal arrhythmia has important clinical potential value.