胎儿心脏超声在胎儿心律失常中的临床价值分析

目的探究超声心动图在胎儿心律失常诊断中的临床运用价值。方法回顾性分析109例胎儿心律失常孕妇的临床资料,同一孕妇均采用常规产前检查和超声心动图检查,比较两种方法在胎儿心律失常检出率方面的差异。结果房性期前收缩和室性期前收缩的检出率两种方法比较差异无统计学意义（P〉0.05）;超声心动图对窦性心动过速和窦性心动过缓的检出率高于产前常规检查（P〈0.05）;超声心动图分别检出3例室上性心功过速和1例心房扑动,常规产前检查却未能检出;超声心动图对胎儿心律失常总检出率高于常规产前检查（100%vs 86.2%,P〈0.05）。结论超声心动图检查方法无创、简便、有效,对胎儿心律失常的有无及其类型的诊断能提供较为准确的诊断依据。     

超声速度向量成像技术在胎儿心律失常诊断及治疗中的初步应用

目的探讨超声速度成像(VVI)技术在胎儿心律失常诊断及治疗中的应用价值。方法对24例孕(26.5±5.5)周的心律失常胎儿,其中6例室上性心动过速(3例为阵发性室上性心动过速),18例频发房性早搏,行VVI分析,检测心律失常时胎儿心肌速度向量、应变和应变率变化;另选取30例孕(27.0±6.5)周的正常胎儿作为对照组,对比分析2组胎儿心肌速度向量、应变和应变率变化。结果18例频发房性早搏均呈二、三联律,VVI速度向量图显示早搏与正常窦性心律的心脏扭转角度和方向基本一致,应变与应变率与对照组相比差异无统计学意义(P>0.05)。6例室上性心动过速发作时VVI速度向量示心肌运动向量幅度减低,3例发作持续48h的胎儿(心室率230～310次/min)心肌运动向量幅度显著降低,应变及应变率与正常对照组对比降低(P<0.01),常规超声检查可见胎儿水肿及重度二尖瓣、三尖瓣反流;3例阵发性室上性心动过速胎儿与正常对照组应变及应变率相比差异无统计学意义(P>0.05)。对3例室上性心动过速胎儿经胎盘给药行宫内西地兰、地高辛转律及抗心衰治疗后,1例于10d后转律,呈频发房性早搏;2例于18～24d转律,呈窦性心律,VVI检测心肌速度向量及应变与应变率明显改善。3例室上性心动过速胎儿转律及抗心力衰竭治疗后2例39周剖宫产分娩,1例经阴道分娩;3例阵发性室上性心动过速胎儿及18例频发房性早搏胎儿均经阴道分娩,胎儿各项生理指标及心脏各项检测指标正常。结论VVI技术可实时动态分析胎儿心动过速时的快速心率,通过检测心律失常时胎儿心肌运动向量及应变与应变率改变解析胎儿心律失常。     

超声心动图检测胎儿心律失常

目的 探讨超声心动图产前诊断胎儿心律失常的临床价值.方法 行常规胎儿超声心动图检查,在二维超声指导下用M型取样线在心脏切面上同时通过心房壁和心室壁,观察每一心动周期房、室壁的运动曲线及相互之间的节律关系.结果 396例胎儿心律失常中,房性期前收缩276例,室性期前收缩42例,窦性心动过速31例,窦性心动过缓14例,室上性心动过速10例,心房扑动10例,完全性房室传导阻滞7例,6例在检查中出现不规则心律.13例伴有胎儿心脏结构异常,以复杂型先天性心血管畸形为主;9例伴心力衰竭、6例伴胎儿水肿. 结论超声心动图产前诊断胎儿心律失常有一定的临床应用价值,但对某些复杂类型心律失常的诊断仍存在困难.     

脉冲多普勒结合心电图思维诊断胎儿心律失常

目的 探讨脉冲多普勒结合心电图思维方法分类诊断胎儿心律失常的可行性.方法 产前检查发现胎儿心律失常65胎,通过获取肺动、静脉的脉冲波多普勒血流频谱,运用心电图思维方法,分类诊断胎儿心律失常.结果 诊断65胎心律失常,其中窦性心动过缓12胎,窦性心动过速8胎,室上性心动过速5胎,房性期前收缩28胎,室性期前收缩7胎,房室传导阻滞5胎.结论 脉冲多普勒频谱结合心电图思维方法能快速、准确地分类诊断胎儿心律失常.     

超声心动图对胎儿室上性心动过速的诊断及宫内治疗疗效评价

目的探讨超声心动图在胎儿快速心律失常诊断及宫内治疗疗效评价中的应用价值。方法对135例心动过速胎儿分别行M型及多普勒超声心动图检测,其中32例为室上性心动过速(200次/min≤心室率≤310次/min)。对无合并先天性心脏病的胎儿进行母亲常压氧治疗或宫内洋地黄转律治疗,并对比治疗前后超声心动图改变。结果32例室上性心动过速胎儿中合并复杂先天性心脏病者7例,胎儿水肿10例。对7例合并心脏畸形的胎儿终止妊娠;对12例阵发性室上性心动过速和2例心动过速持续发作48~72h、且心室率<250次/min的胎儿行保守治疗,其中8例恢复正常心律和心率,6例转为频发房性早搏伴短阵室上性心动过速并提前分娩;对持续发作组11例(心室率≥250次/min)胎儿经胎盘给洋地黄治疗后均转律成功,其中4例重度水肿胎儿治疗转律时间为15~27d,余7例转律时间为10~15d。出生后新生儿随访期最长24个月,头颅CT、超声心动图等检查显示各项生理指标均正常。结论超声心动图可迅速检出胎儿心律失常,并明确性质。对室上性心动过速胎儿经胎盘给西地兰 地高辛可有效转律,并同时控制胎儿心力衰竭和减轻水肿。     

胎儿心脏超声和常规产前检查在胎儿心律失常诊断中的效果对比

探讨在胎儿心律失常诊断中采取胎儿心脏超声和常规产前检查的临床价值对比。选取2014年6月~2015年6月就诊并确诊为胎儿心律失常的孕妇48例作为研究对象,均行常规产前检查及超声心动图检查,对两组检查方法的诊断准确率进行统计对比。两种检查方法在诊断房性期前收缩、室性期前收缩、窦性心动过速方面比较差异无统计学意义(P>0.05);但超声心动图检查在诊断室上性心动过速、窦性心动过缓、心房扑动等方面的检出率高于常规产前检查,差异有统计学意义(P<0.05);超声心动图检查的准确率(100.00%)高于常规产前检查(79.17%),差异有统计学意义(P<0.05)。在胎儿心律失常诊断中,采取超声心动图检查具有无创、操作简便、诊断准确率高的优点,在临床中具有良好的诊断价值。     

胎儿心电图联合超声心动图检测对胎儿期前收缩判别的意义

[目的]联合应用胎儿心电图与超声心动图检测,以提高胎儿期前收缩的诊断率.[方法]通过产前胎心听诊和(或)胎心率监护筛查出胎儿心律失常的病例,将胎儿心电图(FECG)及胎儿超声心动图(FUCG)诊断为胎儿期前收缩者纳入本研究,评价两种检测方法的一致性及其对胎儿期前收缩诊断的灵敏度和特异度.[结果]FECG发现期前收缩占胎儿心律失常36.8%,FUCG发现期前收缩占胎儿心律失常35.5%,两种检测方法的一致性为0.972;FECG联合FUCG判断室上性期前收缩的灵敏度和特异度分别为95.95%、89.17%,判断室性期前收缩灵敏度和特异度分别为93.55%、96.50%.[结论]FECG与FUCG判定胎儿期前收缩有很好的一致性;对期前收缩性质的判断,采用FECG联合FUCG检测可弥补其相互不足,提高胎儿期前收缩判断准确度.     

胎儿先天性胆总管囊肿产前超声诊断价值及出生后随访分析

目的：通过分析胎儿先天性胆总管囊肿的产前超声声像图特征及出生后随访结果,探讨胎儿先天性胆总管囊肿的产前超声诊断价值。方法：回顾性分析2018年1月—2020年1月在浙江大学医学院附属妇产科医院进行产前超声检查并确诊胎儿为先天性胆总管的34例孕妇的产前超声声像图以及出生后患儿的随访资料,最终将产前诊断结果与手术后病理进行对比,总结产前超声图像特点,分析产前超声诊断价值及出生后预后情况。结果：34例胎儿中,5例选择引产（14.7%）,继续妊娠至分娩29例（85.3%）。3例于36周+行剖宫产分娩,26例妊娠至足月后分娩。25例患儿出生后复查超声检查提示先天性胆总管囊肿,均接受手术治疗,手术时间均在出生后的3个月内,手术病理结果证实为先天性胆总管囊肿。余4例中2例出生后腹部超声提示为肝囊肿,1例腹部超声及MRI提示正常,1例出生后诊断为胆道闭锁。产前产后的诊断符合率为73.5%(25/34),误诊率11.8%(4/34)。胎儿胆总管囊肿的超声图像特征表现为右上腹肝门部或胆囊旁的囊肿,囊壁薄,与胆囊和/或其周围肝内胆管相通,彩色多普勒显示囊肿内无血流信号。结论：先天性胆总管囊肿可通过产前超声发...     

彩色多普勒超声心动图在胎儿心律失常中临床应用探讨

目的:探究胎儿心律失常应用彩色多普勒超声心动图检查的临床价值。材料与方法:选取本院2015年1月-2016年1月收治的疑似胎儿心律失常孕妇180例临床资料予以回顾性地分析,所有孕妇均应用彩色多普勒超声心动图检查,并于胎儿出生后予以随访,观察和比较其诊断价值。结果:在本研究疑似胎儿心律失常孕妇180例中,通过彩色多普勒超声心动图检查后发现胎儿心律失常者出现36例(20.00%),其中先天心脏病2例(5.56%)、房扑1例(2.78%)、室性早搏4例(11.11%)、房性早搏17例(47.22%)、心动过缓2例(5.56%)、心动过速10例(27.78%),包括室上型心动过速7例(19.44%)、窦性心动过速3例(8.33%);在胎儿心律失常36例中,先天心血管畸形出现3例(8.33%),包括部分心内膜垫缺损1例(33.33%)、主动脉缩窄2例(66.67),且分别对应室上型心动过速、心动过缓;彩色多普勒超声心动图诊断误诊率、准确率和胎儿出生后实际情况对比未显示高度差异(P0.05)。结论:胎儿心律失常应用彩色多普勒超声心动图检查价值较高,能够降低误诊率,提高诊断准确率,于早期对胎儿的心脏结构状况与心律失常类型加以明确,为临床妊娠终止和采取有效干预措施提供参考,可应用于临床。     

频谱多普勒及M-型超声心动图检测胎儿心律失常的临床研究

目的：探讨频谱多普勒及M-型超声心动图对胎儿心律失常的诊断价值。方法：采用彩色多普勒超声心动图对孕龄16～41周的临床疑诊胎儿心律失常或存在其他异常的226例胎儿进行研究。结果：共检出胎儿心律失常53例(23．5％)，其中期前收缩40例(房性期前收缩35例，室性期前收缩5例包括室性早搏二联律、室性早搏三联律各1例)。心动过缓7例，心动过速4例，2：1房室传导阻滞、房扑各1例。53例心律失常胎儿中并发先天性心血管畸形4例(二尖瓣闭锁1例，共同房室通道1例，单心室伴肺动脉瓣狭窄1例，心脏肿瘤1例)。结论：胎儿频谱多普勒及M-型超声心动图是检出胎儿心律失常的可靠的无创性影像诊断技术，其应用有助于早期检出并指导心律失常胎儿的处置。     

Effectiveness and characteristics of the action of etmozin in treating extrasystole in middle-aged and elderly patients

Antiarrhythmic efficiency and specific effects of ethmozine, taken alone in increasing oral doses from 300 to 450 mg daily, were evaluated in 48 elderly and old coronary patients with stable supraventricular and ventricular extrasystoles (SVES, VES). It was demonstrated clinically and instrumentally (ECG, rhythmography, bicycle ergometry with standard exercise, cardiac rhythm monitoring and computer analysis, polycardiography, tetrapolar chest rheography) that ethmozine's antiarrhythmic effect was marked (a more than 75% post-treatment decline in the frequency of extrasystoles at rest and during exercise, provided that paired polytopic extrasystoles and paroxysms of tachycardia are suppressed completely) in 52.1% of SVES patients and 60% of VES patients. Antiarrhythmic action of a 300 mg ethmozine load dose was particularly apparent within 2-7 hours after administration. Ethmozine treatment, as described above, delayed atrioventricular conduction, causing however no significant decrease in heart rate, nor depressing cardiac output and myocardial function; arterial blood pressure and myocardial oxygen requirement remained basically unchanged either. Unlike propranolol effect on cardiac rhythm undulating pattern, there is evidence that ethmozine mechanism of action involves sympathetic activation. Ethmozine had to be discontinued in 10.4% of the 35.4% of patients with side effects.     

Flecainide in the intrauterine treatment of fetal supraventricular tachycardia.

OBJECTIVES: To assess the efficacy of flecainide in the intrauterine treatment of fetal supraventricular tachycardia (SVT) with 1 : 1 atrioventricular conduction. DESIGN: Twenty fetuses (21-35 weeks of gestation) with SVT ranging between 215 and 280 bpm were analyzed retrospectively. Fetuses received flecainide and digoxin as either first, second or third line therapy. Intracardiac blood flow, venous Doppler waveforms and cardiotocograms were evaluated before and after drug induced conversion to sinus rhythm. RESULTS: After initiation of combined flecainide and digoxin therapy, the median time interval until final conversion to sinus rhythm was 5 days (range, 0-14 days). The majority of fetuses (n = 15; 75%) converted to sinus rhythm within 7 days of treatment, whereas the remaining five (25%) showed initial reduction of the heart rate to 160-215 bpm over several days, with restoration of a triphasic venous blood flow pattern before late conversion within 7-14 days after initiation of flecainide treatment. One of these fetuses showed a decrease in fetal heart rate to 160-190 bpm without conversion to sinus rhythm but with resolution of hydrops. All fetuses survived. CONCLUSIONS: Flecainide is safe and highly effective in the intrauterine treatment of hydropic fetuses with supraventricular tachycardia. Conversion into sinus rhythm can be expected 72 h after initiation of therapy but may take up to 14 days. Therefore therapy should be continued beyond 72 h, especially when an initial decrease of fetal heart rate is observed which may represent an early therapeutic response.     

胎儿阵发性室上性心动过速的超声诊断及治疗

目的探讨胎儿阵发性室上性心动过速（SVT）的产前超声诊断方法及常压氧疗法的疗效。方法应用胎儿多普勒超声心动图对从2250例心律失常胎儿中遴选的29例阵发性SVT进行心率、心律变化的分析,采用常压氧疗法治疗干预并对治疗前后胎儿心功能指标进行比较。结果29例阵发性sVT胎儿均于检查后行常压氧治疗干预,第1个疗程转律15例,第2个疗程转律12例（含3例转偶发早搏）;1例发生频发房性早搏;1例10d后发生持续性SVT。两个疗程常压氧治疗总有效率为93．1％。治疗前后心脏各指标对比明显改善。结论胎儿阵发性室SVT多由频发房性早搏导致,通常不出现心功能异常。常压氧疗法可有效抑制短阵房性心动过速,改善胎儿循环功能及提高血氧饱和度。     

胎儿不规则心律的超声观察与预后分析

[摘要] 目的 总结不规则胎儿心律的产前超声表现，并进一步探讨其临床意义及胎儿预后。方法 利用彩色多普勒超声对103例不规则心律的胎儿进行研究，回顾分析其临床表现、诊断方法，结合产后随诊结果进行分析。结果：产后新生儿均存活。产后心律恢复正常的为89例（86.4%）；出生后持续存在心律失常现象的为14例（13.6%）。其中窦性心律不齐6例；偶发室性早搏2例；偶发房早5例（其中伴动脉导管未闭1例），频发房早伴偶发二联律、并有房间隔缺损者1例。结论 大多数不规则胎儿心律的预后良好，多数可自行消失。超声多普勒是检测不规则胎儿心律的主要方法。     

Rate-based management of fetal supraventricular tachycardia.

We reviewed the ultrasonographic studies and the clinical course of 22 fetuses with supraventricular tachycardia to determine whether the heart rate alone could serve as a basis for conservative management. Hydrops was not encountered with heart rates under 230 beats per minute. The conditions of all 22 fetuses stabilized without invasive administration of medications. Eighteen were delivered vaginally and only four by cesarean section. No fetal or neonatal losses occurred. Regardless of the type of supraventricular tachycardia, reducing heart rate in these fetuses to levels preventing or resolving hydrops allowed term vaginal delivery, thereby reducing the substantial problems of ventilating an immature or hydropic neonate.     

Characterization of fetal arrhythmias by means of fetal magnetocardiography in three cases of difficult ultrasonographic imaging

Characterization of ultrasound detected fetal arrhythmias is generally performed by means of M-mode and pulsed Doppler echocardiography (fECHO), sonographic techniques that allow only indirect and approximate reconstruction of the true electrophysiological events that occur in the fetal heart. Several studies demonstrated the ability of fetal magnetocardiography (fMCG) to identify fetal arrhythmias. We report on three women, studied after the 32nd gestational week, who were referred for fMCG because of unsatisfying fetal cardiac visualization with fECHO due to maternal obesity, fetus in constant dorsal position hiding the fetal heart, intrauterine growth retardation, and oligohydramnios. Minor pericardial effusion was present in the third patient and digoxin therapy was given. FMCG were recorded with a 77-channel MCG system working in a shielded room. Independent Component Analysis (FastICA algorithm) was used to reconstruct fetal signals. The good quality of the retrieved fetal signals allowed real-time detection of arrhythmias and their classification as supraventricular extrasystoles (SVE), with/without aberrant ventricular conduction and/or atrioventricular block. The time course of the fetal cardiac rhythm was reconstructed for the entire recording duration; hence, fetal heart rate variability could be studied in time and frequency. Since isolated extrasystoles may progress to more hazardous supraventricular tachycardias, the noninvasive antenatal characterization of, even transient, fetal arrhythmias and their monitoring during pregnancy can be of great clinical impact.     

Treatment of fetal supraventricular tachyarrhythmias

Supraventricular tachyarrhythmia has been encountered in 18 fetuses at the Yale-New Haven Medical Center during the past 4 years. Fourteen of these fetuses had supraventricular tachycardia and underwent in utero antiarrhythmic therapy with maternally administered digoxin either alone, or on combination with verapamil, propranolol, or procainamide. Thirteen of the 14 fetuses had successful in utero conversion of cardiac rhythm to normal sinus rhythm. The 14th patient underwent successful therapy after birth. All 14 fetuses survived despite severe fetal hydrops at the time of diagnosis in 13 of 14. The four remaining fetuses had either atrial flutter (3) or fibrillation. Two of the fetuses with atrial flutter died at birth, the 3rd survived after electrical cardioversion at birth. The fetus with atrial fibrillation converted to normal sinus rhythm and survived after maternal administration of digoxin. Using M-mode and pulsed Doppler echocardiography, the nature and electrophysiologic mechanism of the arrhythmia may be deduced. The latter information is reviewed along with the fetomaternal pharmacology of various antiarrhythmic agents to devise a rational antiarrhythmic treatment program.     

胎儿超声心动图评价胎儿心动过速的诊断及治疗干预

目的应用胎儿超声心动图诊断胎儿快速心律失常并对宫内干预治疗室上性心动过速（SVT）进行跟踪评价。 方法对已检出的1910例心律失常胎儿中的125例快速心律失常者，分为窦性心动过速、SVT、SVT合并心力衰竭（心衰）3组，对后两组胎儿进行宫内地高辛转律治疗。 结果胎儿心动过速125例（心率≥180O次／min），其中SVT29例（含房颤、房扑7例）；余为窦性心动过速96例。SVT组中合并复杂先天性心脏病者7例，胎儿水肿7例。合并先心病均于检查后中止妊娠，其余22例行常压氧治疗或经胎盘给药，首选药物为地高辛。新生儿随访期最长16个月，头颅CT、超声心动图等各项生理指标均正常。 结论胎儿超声心动图是目前唯一可迅速检出胎儿心律失常并明确性质的诊断手段，且重复性好。地高辛经胎盘给药治疗可有效转律并同时控制胎儿心衰减轻水肿且无致畸作用。