左心发育不良综合征胎儿大脑前动脉血流参数研究

Blood Flow Parameters of Anterior Cerebral Artery in Fetus with Hypoplastic Left Heart Syndrome

目的检测中晚孕期左心发育不良综合征(HLHS)胎儿大脑前动脉(ACA)多普勒血流参数变化。资料与方法使用多普勒超声对34例HLHS胎儿和34例孕龄配对的正常胎儿进行ACA 2个节段(ACAS1和ACAS2)和大脑中动脉(MCA)血流参数测量,包括速度参数[收缩期峰值流速(PSV)和舒张末期峰值流速(EDV)]、阻力参数[搏动指数(PI)和阻力指数(RI)]。比较两组各血流参数的差异及HLHS组ACAS1、ACAS2和MCA的PI异常率差异;绘制散点图、拟合最佳曲线分析HLHS组头围分别与ACAS1、ACAS2和MCA PI的相关性。结果HLHS组的ACAS1、ACAS2和MCA的PSV与正常组比较,差异无统计学意义(P>0.05),HLHS组的ACAS1、ACAS2和MCA的EDV均显著高于正常组(P均<0.05);HLHS组胎儿的ACAS1、ACAS2和MCA的PI及RI均显著低于正常组(P均<0.05)。HLHS组ACAS1和ACAS2的PI异常率[分别为41%(14/34)、35%(12/34)]均明显高于MCA的PI异常率[17%(6/34),P均<0.05]。HLHS组胎儿头围明显小于正常组(P<0.05),并与ACAS1、ACAS2、MCA的PI呈正相关(P<0.05)。结论HLHS胎儿ACA和MCA的多普勒阻力参数明显减低,而且ACA异常率较MCA高,评估ACA多普勒血流参数可为HLHS胎儿脑血流动力学研究提供有力补充。

Purpose To examine the blood flow Doppler parameters changes of anterior cerebral artery(ACA)in fetus with hypoplastic left heart syndrome(HLHS)among the second and third trimester of gestation.Materials and Methods Doppler ultrasound was taken to measure two ACA segments(ACAS1 and ACAS2)as well as blood flow of middle cerebral artery(MCA)in 34 HLHS fetus and 34 normal fetus with matched gestation ages,including speed parameter[peak systolic velocity(PSV)and end diastolic velocity(EDV)],resistance parameter[pulsatility index(PI)and resistance index(RI)].The difference of blood flow in the two groups and PI abnormal rate of ACAS1,ACAS2 and MCA in HLHS group were compared.Scatter plot was drawn and best-fit curve was taken to analyze correlation between head circumference and ACAS1,ACAS2 and MCA PI in HLHS group.Results Regarding comparison of each blood parameter in the two groups,PSV difference of ACAS1,ACAS2 and MCA in HLHS was of no statistical significance(P>0.05)and EDV of ACAS1,ACAS2 and MCA in HLHS group was higher than that in the normal group(all P<0.05).PI and RI of fetal ACAS1,ACAS2 and MCA in HLHS group were greatly lower than that in the normal group(all P<0.05).PI abnormal rate of ACAS1 and ACAS2 in HLHS group[41%(14/34)and 35%(12/34)]was all higher than that of MCA[17%(6/34),all P<0.05].Fetal head circumference in HLHS group was remarkably lower than that in the normal group(P<0.05)and was of positive correlation to the PI of ACAS1,ACAS2 and MCA(P<0.05).Conclusion Doppler resistance parameters of HLHS fetal ACA and MCA is obviously reduced and ACA abnormal rate is higher than that of MCA.The evaluation of ACA Doppler blood parameters could be powerful supplement to the study of HLHS fetal cerebral hemodynamics.