组织多普勒成像技术对脐绕颈胎儿出生后左心功能的评估价值

Application value of tissue Doppler imaging technique in the evaluation of left ventricular function of the fetuses with cord round the neck and neonates

目的探讨组织多普勒成像技术在脐绕颈胎儿及出生后新生儿左心功能评价中的应用价值。方法收集脐绕颈胎儿89例作为研究对象,根据脐动脉S/D值分为:脐绕颈且S/D<3组(Ⅰ组)及脐绕颈且S/D≥3组(Ⅱ组),选择同期无脐绕胎儿139例作为对照组。应用组织多普勒成像技术测量所有胎儿及出生后新生儿二尖瓣环心肌运动速度(Ea、Aa、Sa)、等容收缩时间(ICT)、等容舒张时间(IRT)及射血时间(ET),计算Ea/Aa值及Tei指数。比较3组胎儿及出生后新生儿上述各参数。结果与Ⅰ组及对照组相比,Ⅱ组胎儿及新生儿Ea、Aa、Sa及Ea/Aa值均减低,差异均有统计学意义(P均<0.05),左心室Tei指数及ICT+IRT均增高,差异均有统计学意义(P均<0.05),ET减低,但差异无统计学意义(P>0.05);与对照组相比,Ⅰ组胎儿及新生儿Ea、Aa、Sa、Ea/Aa值、左心室Tei指数、ICT+IRT及ET差异均无统计学意义(P均>0.05);3组新生儿Ea、Aa、Sa及Ea/Aa值均高于相应组胎儿,差异均有统计学意义(P均<0.05);3组新生儿左心室Tei指数及ICT+IRT均低于相应组胎儿,差异均有统计学意义(P均<0.05),ET高于相应组胎儿,但差异无统计学意义(P>0.05)。结论脐绕颈且脐动脉S/D≥3时胎儿左心舒张功能、收缩功能及整体心功能均受到损害,且这一损害延续到了新生儿期。

Objective To investigate the application value of tissue Doppler imaging technique in the evaluation of left ventricular function of the fetuses with cord round the neck and neonates.Methods A total of 89 fetuses with cord round the neck were enrolled in the study,who were divided into two groups according to the S/D ratio of umbilical artery:groupⅠ(S/D<3)and groupⅡ(S/D≥3),at the same time,the other 139 fetuses without cord round the neck were enrolled as control group.The velocities including Ea,Aa,Sa peak of mitral annulus,the isovolumic contraction time(ICT),isovolumic relaxation time(IRT)and ejection time(ET)were measured by tissue Doppler imaging,and the Ea/Aa and Tei index were calculated.Results The levels Ea,Aa,Sa and Ea/Aa in groupⅡwere significantly lower than those in control group and groupⅠgroup(P<0.05),however,the Tei index of left ventricle and ICT+IRT in groupⅡwere significantly increased(P<0.05).The ET of left ventricle in groupⅡwas decreased,but there was no significant difference between groupⅡand control group as well as groupⅠ(P>0.05).There were no significant differences in Ea,Aa,Sa,Ea/Aa,the Tei index of left ventricle,ICT+IRT and ET between groupⅠand control group(P>0.05).Moreover the levels of Ea,Aa,Sa and Ea/Aa in neonates were significantly higher than those of fetuses(P<0.05),however,the Tei index of left ventricle and ICT+IRT in neonates were significantly lower than those of fetuses(P<0.05).There was no significant difference in ET between neonates and fetuses(P>0.05).Conclusion The heart function of fetuses with cord round the neck and S/D≥3 is damaged,which continues upto neonatal period.