正常妊娠和胎儿生长受限孕妇肝静脉血流动力学和心输出量的变化

Maternal hepatic venous hemodynamics and cardiac output in normal and fetal growth restricted pregnancies

目的:评价正常妊娠(uncomplicated pregnancy,UP)和胎儿生长受限(fetal growth restriction,FGR)孕妇的肝静脉血流动力学和心输出量(cardiac output,CO)与胎儿生长发育之间的关系。方法:用彩色多普勒超声测量FGR组和UP组孕妇的肝静脉血流阻力指数(hepatic venous impedance,HVI)、静脉脉搏传递时间(venous pulse transit time,VPTT)及CO。记录各孕妇的新生儿体重及体重百分比。结果:UP组随孕周增加,HVI降低,VPTT增加,CO增多;FGR组较孕周相当UP组HVI值更高,VPTT值更短,CO更低,新生儿出生时体重更低,胎儿娩出时胎龄更小(P<0.05)。结论:中晚期正常孕妇随孕周增加,肝静脉血流动力学发生适应性改变;FGR孕妇的肝静脉血流动力学和CO适应不良与胎儿生长受限存在重要的联系。

Objective： To evaluate relationship of maternal hepatic vein Doppler fl ow parameters and cardiac output （CO） with neonatal birth weight in uncomplicated pregnancies （UP） and pregnancies complicated by fetal growth restriction （FGR） . Methods： Hepatic vein impedance index （HVI）, venous pulse transit time （VPTT ）, and CO were measured in women with UP at the 14th–37th weeks and complicated by FGR at the 26th–37th weeks who underwent maternal hepatic hemodynamic and echocardiographic examination during the ultrasonography. Aft er delivery, the birth weight and the birth weight percentile of each neonate in this study were recorded. Correlations among HVI, VPTT , and CO were analyzed. Results： In the UP group, HVI, VPTT, and CO changed with the increase of gestation. In the FGR group, HVI was higher, VPTT was shorter, CO and neonatal birth weight were obviously lower than those in the UP at the 26th–37th weeks （P〈0.05）. Conclusion： There is a series of adaptive changes in hepatic venous hemodynamics and CO in UP with the increase of gestation to meet the demand of fetal growth, while the maladaptive changes in hepatic venous hemodynamics and CO in pregnant woman may contribute to FGR.