产前超声心动图对单纯卵圆孔血流受限胎儿分娩方式的指导价值

The Guiding Value of Prenatal Echocardiography in the Delivery Mode of Fetuses with Restricted Foramen Ovale Flow

探讨产前超声心动图对单纯卵圆孔血流受限胎儿分娩方式的指导价值。选取105例单纯卵圆孔血流受限胎儿为研究对象并随访至分娩,根据分娩孕周分为早发组(n=30,孕周<37周)、晚发组(n=75,孕周≥37周),比较两组卵圆孔血流速度、卵圆孔瓣大小、静脉导管A波倒置或消失、动脉导管形态异常、心胸比、右心房/左心房(RA/LA)、右心室/左心室(RV/LV)、三尖瓣反流程度。结果显示,早发组心胸比、RA/LA、RV/LV、三尖瓣反流程度高于晚发组(P<0.05);心胸比、RA/LA、RV/LV、重度三尖瓣反流均与提前行剖宫产分娩相关(P<0.05);RA/LA、RV/LV、心胸比、重度三尖瓣反流预测提前行剖宫产分娩的受试者操作特征(ROC)曲线的曲线下面积(AUC)分别为0.764、0.757、0.792、0.550,以上各参数联合预测提前行剖宫产分娩的AUC为0.929。可见产前超声心动图联合检测RA/LA、RV/LV、心胸比、重度三尖瓣反流对分娩方式具有重要的指导价值。

This paper investigated the value of prenatal echocardiography in guiding the delivery mode of fetuses with restricted flow in the simple foramen ovale.105fetuses with restricted flow through the foramen ovale alone were selected and followed up until delivery.They were divided into early-onset group(n=30,gestational week<37weeks)and late-onset group(n=75,gestational week≥37weeks)according to the gestational week of delivery.Compared the velocity of flow through the foramen ovale,size of the foramen ovale valve,inversion or disappearance of the A wave of the venous duct,abnormal morphology of the arterial duct,cardiothoracic ratio,and right atrium/left atrium (RA/LA),right ventricle/left ventricle (RV/LV),and degree of tricuspid regurgitation.The results showed that the degree of cardiothoracic ratio,RA/LA,RV/LV,and tricuspid regurgitation were higher in the early-onset group than in the late-onset group(P<0.05).The cardiothoracic ratio,RA/LA,RV/LV,and severe tricuspid regurgitation were all associated with early cesarean delivery (P<0.05).The area under the curve of the working characteristics of subjects with RA/LA,RV/LV,cardiothoracic ratio,and severe tricuspid regurgitation predicting early cesarean delivery was 0.764,0.757,0.792,and 0.550,respectively,and the AUC for the combination of these upper parameters to predict early cesarean delivery was 0.929.It is evident that the combination of prenatal echocardiography to detect RA/LA,RV/LV,cardiothoracic ratio,and severe tricuspid regurgitation has important value in guiding the mode of delivery.