多普勒超声研究妊娠期左心室结构和功能的变化

Study on Left Ventricular Structure and Function Changes in Normal Pregnant Women by Doppler Ultrasound

目的 探讨正常妊娠孕妇血流动力学变化对心脏结构和心功能的影响。方法 随机选择健康初孕妇女30例作为研究组,同期健康育龄未孕妇女21例作为对照组。用彩色多普勒超声,在妊娠的早、中和晚期作三次超声心动图检查。结果 妊娠妇女的左心室壁明显增厚,收缩和舒张末期内径和容积增大。收缩功能指标如搏出量（SV）、心输出量（CO）及心脏指数（CI）较对照组均明显增加,射血分数（EF）在早孕期和中孕期轻度增加,在晚孕期则轻度降低,与对照组比较均无显著差异。E/A值在妊娠晚期为1.13±0.36,显著低于对照组的1.68±0.25及妊娠早期的1.61±0.25（P<0.01）。肺静脉血流频谱的D峰及D峰的速度时间积分（DVTI）在妊娠期逐渐降低,肺静脉反向血流AR峰在妊娠期明显增加,晚期妊娠时为26.95±2.60,与对照组的18.37±3.32及早孕期的17.63±2.68比较均有非常显著性差异（P<0.01）。结论 正常孕妇左心室室壁增厚,舒张和收缩末期的内径和容积均增加。收缩功能在妊娠期无明显改变,而舒张功能则轻度受损。

Objective To investigate the effects of hemodynamic changes on the cardiac structure and function in normal pregnant women. Methods Thirty randomly selected primigravidas were studied with color Doppler echocardiography in early, mid and late gestations with 21 normal non-pregnant women as controls. Results In the normal pregnant women, the wall thickness, diastolic diameter, systolic diameter and volume of the left ventriculle increased significantly. The systolic function parameters such as SV, CO and CI gradurally increased with pregnancy in all three trimesters, and EF slightly increased in early and mid gestation but decreased in late gestation. Compared with the control group there was no significant difference in EF. The E/A ratio of late pregnancy was 1. 13±0. 36, It was significantly lower than in early pregnancy and that of the control group ( P<0. 01). D and DVTI significantly decreased in late pregnancy. AR in late pregnancy was 26. 95±2. 60cm/s, being significantly higher than that of control group which was 18. 37± 3.32cm/s( P<0.01). Conclusion In normal pregnant women, the wall thickness, end -systolic and end - diastolic volume of the left ventriculle were significantly increased. There was no significant change in systolic function, but diastolic function was slightly damaged.