胎儿Mod-MPI自动测量法评估正常胎儿左心室功能的纵向研究

Longitudinal study of fetal left modified myocardial performance index measured by auto Mod-MPI system

目的建立正常胎儿左心改良心肌做功指数(modified myocardial performance index,Mod-MPI,Mod-MPI)自动测量法的正常参考值范围,以及各相关参数与孕周的关系。方法选择2017年1月至2019年1月在湖北省妇幼保健院定期检查并分娩的正常孕妇进行前瞻性纵向研究,于孕11~13^(+6)周、20~24周、28~32周、孕36~40周行胎儿超声检查,并于中晚孕期通过手动法及自动法获得胎儿Mod-MPI、等容收缩时间(isovolumic contraction time,ICT)、等容舒张时间(isovolumic relaxation time,IRT)、射血时间(ejection time,ET),记录并分析数据。结果197名孕妇经筛选后入组,分析数据:①自动测量系统和传统手动法获得的Mod-MPI差异无统计学意义(P>0.05);②20~24周、28~32周、孕36~40周3个孕期,Mod-MPI由0.48增加到0.53,ICT、IRT也随孕周而增加,ET则随孕期的增加而减小。结论Mod-MPI自动测量法操作简便,便于临床推广及应用,应用Mod-MPI自动测量系统建立左心功能正常参考值范围,为宫内评价高危胎儿心功能,选择分娩时机提供理论依据。

Objective To establish normal reference ranges for the fetal left modified myocardial performance index(Mod-MPI)measured by the Auto Mod-MPI systemand to evaluatethe relationship between the parameters and gestational weeks.Methods A prospective longitudinal study was conducted among normal pregnant women who were regularly examined and delivered in Hubei Maternal and Child Health Hospital from January 2017 to January 2019.Ultrasonography was performed at 11-13.6 weeks,20-24 weeks,28-32 weeks and 36-40 weeks of pregnancy.Mod-MPI,isovolemic systolic time(ICT),isovolumic relaxation time(IRT)and ejection time(ET)were obtained manually and automatically during the second and third trimesters of pregnancy.Then record and analyze thedata.Results 197 pregnant women were screened and enrolled in the group.Analytical date show that:①There was no significant difference in Mod-MPI obtained by automatic measurement system and traditional manual method(P>0.05).②Mod-MPI increased from 0.48 to 0.53 during the three gestational periods of 20~24 weeks,28~32 weeks and 36~40 weeks.ICT and IRTalso increased with gestational age,while ET decreased.Conclusions Mod-MPI automatic measurement method is easy to operate and easy to be popularized and applied in clinic.Auto Mod-MPI system was used to establish the normal reference ranges of the fetal left modified myocardial performance index.To provide theoretical basis for intrauterine evaluation of cardiac function of high-risk fetuses and selection of delivery time.