超声监测早孕期胎心率变化规律的初步研究

Investigation of ultrasound monitoring of embryonic/fetal heart rate changes during early pregnancy

目的初步探讨早孕期胎儿心率变化规律,建立参考值范围。方法收集2016年1月至2018年1月于我院产前检查的早孕期胎儿的胎心率及孕妇的相关临床资料。应用超声测量胎儿胚芽或头臀长(CRL),观测胎心搏动,M型超声或脉冲多普勒测量胎心率。结果孕龄40~41 d或CRL 2~3 mm时胎心率为(117.31±11.64)次/min,胎心率随着孕龄或CRL逐渐增加而上升,并在孕龄63~69 d或CRL 23~30 mm时胎心率达到峰值(172.69±9.27)次/min,随后胎心率随着孕龄或CRL的增长缓慢下降,趋于稳定。基于各时期胎心率变化规律建立回归方程:胎心率=-223.751+11.746孕龄-0.086孕龄^2(R^2=0.772,R=0.877,P<0.001);胎心率=101.83+5.108CRL-0.084CRL^2(R^2=0.765,R=0.875,P<0.001)。结论以孕龄及CRL为基准,初步建立了早孕期第5、50、95百分位胎心率参考值范围,为临床预测流产风险提供参考依据。

Objective To establish preliminarily the reference range of embryonic/fetal heart rate(EHR)during early pregnancy,and to explore its rules.MethodsThe EHR and clinical data of pregnant women and embryos from January2016 to January 2018 in our hospital were collected.Embryonic/crown-rump length(CRL)and the heartbeat was detected by ultrasound.EHR was measured by M mode ultrasound or pulse Doppler.ResultsWhen CRL was 2~3 mm or gestational age(GA)was 40~41 d,the EHR was(117.31±11.64)beat/min.EHR increased with the GA/CRL gradually increasing,and at the 63~69 d of the GA or CRL was 23~30 mm,the EHR reached the peak of(172.69±9.27)beat/min.After that,the EHR gradually decreased and tend to be stable with the increase of GA or CRL.The regression equation was established based on the changes of EHR in each period:EHR=-223.751+11.746 GA-0.086 GA^2(R^2=0.772,R=0.877,P<0.001),EHR=101.83+5.108 CRL-0.084 CRL^2(R^2=0.765,R=0.875,P<0.001).ConclusionBased on the GA and CRL,the reference range of EHR for the 5 th,50 th and 95 th percentiles in the early pregnancy period is initially established,which can provide a reference for abortion risk prediction in clinic.