正常胎儿肺静脉血流多普勒频谱分析及其临床意义

目的研究正常胎儿肺静脉血流频谱及其血流参数的正常参考范围。方法应用彩色多普勒超声诊断系统检测233例20～40孕周的正常胎儿的肺静脉血流频谱，测量其血流参数：心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期速度(A)、时间速度积分(TVI)，计算S／D、静脉峰值速度指数(PVI)、静脉搏动指数(PI)。结果正常胎儿典型肺静脉血流频谱为三相波型：心室收缩期波峰、心室舒张期波峰及心房收缩期波谷，前向血流持续整个心动周期。S、D、A及TVI与胎龄呈良好的正相关，PVI、PI与胎龄呈良好的负相关，S／D与胎龄无明显相关关系。结论胎儿肺静脉血流频谱的产生主要由于左房与肺静脉之间的压差引起，左心房压力的改变有可能影响肺静脉血流频谱。胎儿肺静脉血流频谱及血流参数S、D、TVI、PVI、PI与孕周有良好的相关性。     

肺静脉血流检测对妊娠高血压疾病胎儿左心舒张功能的评价

目的通过胎儿肺静脉血流参数评价妊娠高血压疾病对胎儿左心舒张功能的影响。方法应用彩色多普勒检测90例妊娠高血压孕妇,及其孕龄匹配的正常孕妇60例胎儿肺静脉频谱,测量肺静脉血流参数:心室收缩期峰值流速S、心室舒张期峰值流速D、心房收缩期峰值速度A、搏动指数(PI)及静脉峰值速度指数(PVIV)。结果重度子痫前期组血流参数A较健康对照组减低,PI、S/A及PVIV增高(P0.01);重度子痫前期组血流参数A较轻度子痫前期组及妊娠高血压组减低,PI、S/A及PVI增高(P0.05);轻度子痫前期组血流参数A较正常组减低,PI、S/A及PVI增高(P0.05)。结论通过对胎儿肺静脉检测能够定性及定量判断胎儿左心舒张功能改变。     

正常胎儿静脉血流频谱分析及其临床意义

目的对正常胎儿不同孕周肺静脉、下腔静脉、静脉导管血流频谱进行分析,探讨正常胎儿静脉循环血流动力学变化。方法采用高分辨率血流显像(HDF)技术显示200例20～40周正常胎儿肺静脉、静脉导管及下腔静脉,测量其血流参数:心室收缩期峰值速度(S),心室舒张期峰值速度(D),心房收缩期速度(A)。结果正常胎儿肺静脉、下腔静脉及静脉导管均呈三相波:心室收缩期波峰,心室舒张期波峰及心房收缩期波谷,其中肺静脉及静脉导管频谱前向血流持续整个心动周期,下腔静脉心房收缩期波谷与心室收缩期波峰及心室舒张期波峰呈反向;肺静脉S、D及A随着孕龄的增大而增加(P<0.05);下腔静脉S、D及A在妊娠中早期流速较低,在28周之后流速明显增高(P<0.05);静脉导管S、D及A在孕32+1～36周流速最高(P<0.05);36周后与32+1～36周比较无统计学差异。结论胎儿肺静脉、下腔静脉及静脉导管的流速随着孕周的增加有不同的变化。     

正常中晚孕期胎儿肺静脉血流频谱分析

目的 探讨正常中晚孕期单胎胎儿肺静脉血流频谱特点,建立肺静脉血流参数正常参考值范围.方法 应用彩色多普勒超声检测340例19～40孕周正常单胎胎儿肺静脉血流参数:心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期血流速度(A)、速度时间积分(velocity time integral,VTI)、静脉峰值速度指数(peak velocity index,PVI)、静脉搏动指数(pulsatility index,PI)、心室收缩期峰值速度与心室舒张期峰值速度比值(S/D).结果 肺静脉血流参数S、D、A、VTI随孕龄增大逐渐增高,PVI、PI随孕龄增大逐渐降低,各参数拟合的回归方程均有统计学意义;S/D与孕龄无线性关系.所有病例心房收缩期均无反向血流出现.结论 正常胎儿肺静脉血流频谱形态与成人不同.相关参数正常参考值范围曲线可为评价病理情况下胎儿肺静脉血流变化及心功能改变提供依据.     

肺静脉血流频谱改变对胎儿心脏异常的诊断价值

目的 探讨肺静脉血流频谱改变对胎儿心脏异常的诊断价值.方法 对206例胎龄为22～38周的胎儿行心脏超声检查,根据胎儿心脏是否正常分为正常组146例和异常组60例,异常组中包括心律失常8例和心脏结构异常52例.检测两组肺静脉血流相关参数:S波(收缩期峰值速度)、D波(舒张期峰值速度)、A波(心房收缩期峰值速度),计算S/D、S/A、(S-A) /D(静脉峰值速度指数),比较两组间上述参数,以上参数与胎龄行线性相关性分析.结果 52例心脏结构异常胎儿中,5例肺静脉频谱A波缺失,9例A波反向;8例房性早搏肺静脉频谱中A波提前出现,打乱正常的A-A间期,A波之后可见一高大的S波.正常组与心脏结构异常组中A波正向病例比较:(S-A) /D差异有统计学意义(P＜0.05),其余参数差异无统计学意义(P＞0.05).(S-A) /D与孕周相关系数为-0.156,P-0.061.结论 肺静脉血流参数可作为评价胎儿心脏异常的一项指标.     

妊娠高血压疾病胎儿肺静脉血流参数在左心舒张功能评估中的临床价值

目的 探讨妊娠期高血压疾病(HDCP)胎儿肺静脉(PV)血流参数在左心舒张功能评估中的价值。方法 选择我院产科2017年7月至2018年11月收治的HDCP患者137例(疾病组),其中妊娠高血压49例(A组),轻度子痫前期46例(B组),重度子痫前期42例(C组),选择同期于我院产检的健康孕妇40例(对照组)。对各组胎儿进行心脏超声检查,比较各组胎儿PV血流参数,包括心房收缩期峰值流速(A)、心室收缩期峰值流速(S)、心室舒张期峰值流速(D),肺静脉搏动指数(PI)、肺静脉峰值流速指数(PVIV),分析疾病组各血流参数的相关性。并比较疾病组是否发生新生儿窒息胎儿的PV血流参数。结果 疾病组A峰流速低于对照组,PI、PVIV值高于对照组,差异均有统计学意义(P＜0.05);     

Tei指数联合肺静脉及静脉导管血流参数评估妊娠期高血压患者胎儿心功能

目的应用组织多普勒成像Tei指数及肺静脉、静脉导管血流参数综合评估妊娠期高血压患者胎儿心功能,为产前评估胎儿心功能提供有价值的信息。方法选取孕周28~41+6周的孕妇193例,妊娠期高血压孕妇69例为疾病组,与其孕龄匹配且血压正常的孕妇124例为对照组。测量胎儿的各项参数:(1)Tei指数。(2)肺静脉及静脉导管:心室收缩期峰值流速S、心室舒张期峰值流速D、心房收缩期峰值流速A,并计算S/A、静脉搏动指数PI、静脉峰值流速指数PVIV。随访所有新生儿生后1min Apgar评分。结果疾病组胎儿左、右心室Tei指数均较对照组增高(P0.05);疾病组胎儿肺静脉及静脉导管血流参数S、D、A均较对照组减低(P0.05);疾病组胎儿肺静脉及静脉导管指数S/A、PI、PVIV均较对照组增高(P0.05);疾病组胎儿出生后窒息率均较对照组增高(P0.05)。结论通过对妊娠期高血压患者胎儿左、右心室Tei指数及肺静脉、静脉导管血流参数的研究,可对胎儿心功能变化进行监测。     

超声心动图对糖尿病孕妇胎儿肺静脉血流频谱的动态研究

目的对糖尿病孕妇胎儿肺静脉血流频谱进行动态观察,并与正常胎儿比较,为糖尿病孕妇胎儿左心室舒张功能评价提供客观依据。方法分别在妊娠20～28周、32～38周,应用胎儿超声心动图观察34例糖尿病孕妇和54例正常孕妇的胎儿心脏结构。探测胎儿肺静脉、二尖瓣血流,测量肺静脉S波(收缩期峰值速度)、D波(舒张期峰值速度)、A谷(心房收缩波速度),二尖瓣E峰速度、A峰速度,并计算肺静脉S/D值及二尖瓣E/A值。结果无论在中孕期或晚孕期,研究组肺静脉血流频谱S/D值、A谷速度与正常对照组比较差异有显著性意义(P<0.05),而常规采用的二尖瓣血流E/A值两组间差别无显著性意义(P>0.05)。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变;胎儿肺静脉血流频谱S/D值、A谷速度较二尖瓣血流E/A值能更敏感地反映胎儿左室舒张功能的变化。     

晚孕期胎儿肺静脉多普勒频谱诊断宫内窘迫的价值

目的：研究肺静脉血流频谱在诊断胎儿宫内窘迫中的临床价值，为孕晚期胎儿宫内窘迫的诊断提供更早期、更敏感的指标参数。方法：收集32例宫内窘迫胎儿和132例正常胎儿，分为胎儿窘迫组和正常胎儿对照组。测量胎儿肺静脉的S、D、A峰值和肺静脉、脐动脉、静脉导管、大脑中动脉、母体子宫动脉的搏动指数（PI），比较各参数在胎儿窘迫组和正常组的差异。分析肺静脉血流参数与产后Apgar评分的相关性。结果：胎儿宫内窘迫组和正常组比较S和A峰值均降低，肺静脉峰值速度指数（PVI）增高，差异有统计学意义（P<0.05）。两组间胎儿肺静脉PI升高，大脑中动脉PI/脐动脉PI比值（C/P）降低，差异有统计学意义（P<0.05）。宫内窘迫组胎儿肺静脉PVI值和肺静脉PI值与新生儿Apgar评分有相关性（r=-0.362,P<0.05;r=-0.533,P<0.05），呈负相关趋势。结论：肺静脉血流频谱可以作为检测胎儿宫内窘迫的早期指标，用于指导胎儿宫内窘迫的早期干预和效果监测。     

探讨胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义

目的:研究正常胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义。方法:应用彩色多普勒超声诊断系统检测43例27~36周正常胎儿肺静脉血流,测量它们在呼吸样运动中及无呼吸样运动时的血流频谱参数:心室收缩期峰值速度(S),心室舒张期峰值速度(D),心房收缩期峰值速度(A),静脉搏动指数(PIV),静脉峰值速度指数(PVIV)。结果:呼吸样运动时,PIV、PVIV降低,A升高。结论:胎儿呼吸样运动时,胎儿左房压减小,胎儿左室顺应性增加。     

先天性心脏病所致肺动脉高压患者肝中静脉血流频谱变化特征

目的分析先天性心脏病所致肺动脉高压（PH）患者肝中静脉多普勒血流频谱变化规律,寻找超声无创评价肺动脉高压的新指标。 方法收集第四军医大学唐都医院及沈阳军区总医院2012年1月至2013年6月来院诊治的房间隔缺损、室间隔缺损、动脉导管未闭等拟行封堵术的先天性心脏病患者80例,经右心导管测量肺动脉压力,按照不同肺动脉压力分为健康对照组、轻度PH组、中度PH组、重度PH组,采用超声检测肝中静脉血流频谱,测量心房收缩期离心波峰值血流速度（AR）、收缩期回心波峰值血流速度（S）、舒张期回心波峰值血流速度（D）和速度时间积分（VTI）。 结果健康对照组28例、轻度PH组9例、中度PH组10例、重度PH组22例,各组组间收缩期离心波血流速度时间积分（ARVTI）、收缩期回心波血流速度时间积分（SVTI）、舒张期回心波血流速度时间积分（DVTI）、AR、AR/S、ARVTI/SVTI、AR/（S＋D）、ARVTI/（SVTI＋DVTI）的差异具有统计学意义（F=2.940、2.838、3.373、7.681、3.478、12.052、4.806,P<0.05、<0.05、<0.05、<0.01、<0.05、<0.01、<0.01）。相关分析结果显示AR/（S＋D）比值与肺动脉平均压具有正相关关系（r=0.575,P<0.01）。 结论先天性心脏病患者肝中静脉频谱参数中AR/（S＋D）比值随肺动脉压力的升高而增大,具有相关性。肝中静脉血流频谱的超声探测对肺动脉高压的诊断具有一定参考价值,AR/（S＋D）比值可作为无创评价肺动脉高压的新指标。     

取样容积位置和大小变化对超声检测肺静脉血流的影响

目的评价取样容积位置和大小变化对肺静脉血流频谱的影响.方法 34例正常儿童为研究对象,取样容积(SV)取0.21cm、0.52cm、1.07cm、1.74cm,置于肺静脉左心房开口内0.5cm处,应用多普勒超声技术,分别记录右上、右下、左上及左下肺静脉血流频谱.结果清晰记录到肺静血流脉频谱的成功率分别为右上肺静脉32例(94.1%)、左上肺静脉18例(52.94%)、左下肺静脉9例(26.47%)、右下肺静脉6例(17.65%);四组间有显著性差异(P<0.01).取样容积取 0.21cm时,右上肺静脉血流收缩期峰值流速(S)、加速时间(SAT)、S波速度积分(SI)及舒张期峰值流速积分(DI)与SV取 0.52cm、1.07cm、1.74cm时的测值间有显著性差异(P<0.05),SV取0.52cm、1.07cm、1.74cm时各参数间无显著性差异(P>0.05).结论取样容积位置和大小变化对肺静脉血流参数的检测有影响;SV取0.21cm,置于右上肺静脉内可以比较清晰的显示肺静脉血流频谱.     

Venous Doppler ultrasound in 146 fetuses with congenital heart disease.

OBJECTIVE: To assess the influence of isolated congenital heart disease (CHD) on fetal venous Doppler blood flow velocity waveforms. METHODS: Doppler flow velocimetry was performed in the inferior vena cava and ductus venosus in 146 consecutive fetuses with antenatally diagnosed CHD. Gestational age ranged between 19 and 39 weeks. Fetuses with isolated CHD without non-immune hydrops fetalis (NIHF) (Group A, n = 89) were separated from seven fetuses showing isolated CHD with NIHF (Group B) and 50 cases complicated by chromosomal or other extracardiac malformations, intrauterine growth restriction or non-cardiogenic NIHF (Group C). The control group comprised 109 healthy fetuses of uncomplicated pregnancies. Individual peak velocity index for veins (PVIV) measurements were converted into their Z-scores (delta values) for statistical analysis. RESULTS: There was no statistical difference between fetuses with isolated CHD (Group A) and controls, for the delta PVIV of neither the ductus venosus nor the inferior vena cava. Statistical analysis revealed significant differences between non-isolated CHD fetuses (Group C) and controls for both vessels. However, in a separate analysis of isolated right heart malformations compared with the remaining isolated heart malformations (Groups A and B), a significant difference was observed for the ductus venosus, but not the inferior vena cava. There was an overall survival of 62%. In Group A, 58% of fetuses survived despite increased PVIV and 22% of fetuses with normal venous Doppler had an adverse outcome. All fetuses with cardiogenic NIHF (Group B) died. CONCLUSION: Doppler studies of the ductus venosus and inferior vena cava in fetuses with isolated CHD do not present sufficient alterations to be a reliable marker for screening purposes for CHD in mid-second- and third-trimester fetuses. Furthermore, venous Doppler did not predict fetal outcome in cases of isolated CHD. Abnormal venous Doppler results were mainly attributable to myocardial dysfunction and also to severe right heart obstruction even in the absence of congestive heart failure. Therefore, venous Doppler studies are clinically helpful in indirectly monitoring cardiac function in fetuses with cardiac malformations.     

Totally anomalous pulmonary venous connection and complex congenital heart disease: prenatal echocardiographic diagnosis and prognosis.

OBJECTIVE: The purpose of this study was to determine the accuracy of prenatal cardiac diagnosis, prognosis, and outcome of totally anomalous pulmonary venous connection (TAPVC) and to determine echocardiographic clues in the prenatal diagnosis of isolated TAPVC or TAPVC in association with other complex congenital heart disease (CHD). METHODS: We reviewed our 13-year experience of prenatal diagnosis of TAPVC. Thirteen fetuses were identified with the diagnoses of TAPVC. We systematically analyzed the individual pulmonary veins by color and pulsed Doppler imaging, the presence of a pulmonary venous confluence, the pulsed and color Doppler evaluation of the vertical vein, and sites of connections. Prenatal diagnosis was confirmed by postnatal echocardiography, cardiac catheterization, surgery, or autopsy. RESULTS: The mean gestational age at diagnosis of TAPVC was 26.3 weeks (range, 20-33 weeks). There were 8 fetuses with TAPVC and right isomerism, 3 fetuses with other associated CHD, and 2 with isolated TAPVC. There were 7 fetuses with supracardiac TAPVC, 4 with infracardiac TAPVC, and 2 with mixed TAPVC. Pulmonary vein color and pulsed Doppler data were available in 10 of 13 fetuses. The pulmonary venous confluence was visualized in all fetuses except 1. The vertical vein was visualized in all fetuses. Five fetuses had suspected signs of obstruction. The diagnosis was confirmed postnatally or at autopsy in 12 cases. Eight patients underwent surgery; 6 died, and 2 were alive. Two patients had compassionate care and died; 3 pregnancies were terminated. CONCLUSIONS: It is possible to diagnose accurately complex CHD, including the pulmonary venous connections. When diagnosed prenatally, TAPVC carries a poor prognosis.     

胎儿心脏卵圆孔瓣正常开放与宫内早闭的超声心动图定量分析

目的应用胎儿超声心动图定量分析卵圆孔瓣运动规律以及卵圆孔瓣宫内早闭的血流动力学特点。 方法选取2019年11月至2020年6月在北京百子湾和美妇儿医院进行产前检查,胎儿及母体均未发现异常的孕妇102 例为正常组,依据孕龄将正常组分为3组：组A孕28⁺⁰~32⁺⁶周36例,组B孕33⁺⁰~36⁺⁶周32例,组C孕37⁺⁰~40⁺⁶周34例。另选取超声心动图诊断为胎儿宫内卵圆孔瓣早闭且右心增大的孕妇14例为异常组。应用M型超声心动图检测胎儿卵圆孔瓣运动曲线,测量收缩期（S峰）和舒张期（D峰）运动峰值,S峰持续时间（ST）,1个心动周期持续时间（T）,S峰下降斜率,计算ST/T;应用多普勒超声测量肺动脉瓣、主动脉瓣、动脉导管血流速度,静脉导管阻力指数,脐静脉（腹段）血流速度,跨卵圆孔和下腔静脉入右心房血流速度;应用二维超声测量胎儿卵圆孔径,右心房与左心房横径比值（RA/LA）、右心室与左心室横径比值（RV/LV）。比较并分析各组之间以上参数的差异。 结果正常组胎儿卵圆孔瓣M型超声心动图特点为卵圆孔瓣运动曲线形成的S峰和D峰皆为向左心房单向运动,S峰最大运动峰值大于D峰。正常胎儿S峰最大运动峰值5~7 mm,平均（6.00±0.96）mm。M型超声心动图测量卵圆孔瓣运动曲线S峰运动最大峰值,卵圆孔瓣早闭组与正常组C比较差异有统计学意义［（3.72±0.54）cm vs （6.17±0.94）cm,P＜0.001］,ST/T卵圆孔瓣早闭组较正常组C减小,差异有统计学意义（0.52±0.86 vs 0.59±0.05,P＜0.001）。卵圆孔瓣早闭组胎儿右心扩大,与正常组C比较,RA/LA增大,2组间差异有统计学意义（1.83±0.21 vs 1.19±0.19,P＜0.001）。正常胎儿跨卵圆孔血流速度低于下腔静脉入口血流速度［（40.9±8.9）cm/s vs（52.5±11.5）cm/s,P＜0.05］,卵圆孔瓣早闭组跨卵圆孔血流速度高于下腔静脉入口血流速度［（47.9±10.6）cm/s vs（43.1±7.4）cm/s,P＜0.05］。脐静脉血流速度正常组C高于卵圆孔瓣早闭组,差异有统计学意义［（24.4±4.47）cm/s vs（20.3±5.00）cm/s, P＜0.05］。 结论M型超声心动图显示正常胎儿卵圆孔瓣运动曲线有其自身规律和特点,卵圆孔瓣宫内早闭胎儿卵圆孔瓣开放运动减低。应用M型超声心动图对卵圆孔瓣运动及血流动力学特点进行定量分析研究,有助于准确诊断卵圆孔瓣宫内闭合。     

超声监测胎儿血流动力学变化预测胎儿生长发育的价值

【目的]探讨超声检测胎儿动静脉的血流动力学参数和径线对预测胎儿生长发育的价值。【方法】回顾性分析产前二维超声及彩色多普勒血流显像对170例胎儿进行各项参数测定,根据测定结果,将其分为正常对照组和宫内生长迟缓（IUGR）组,测量脐动脉、大脑中动脉、颈内动脉和腹主动脉的搏动指数（PI）、阻力指数（RI）及脐动脉收缩期最大流速与舒张末期流速的比值（S／D）,测量胎儿静脉导管血流量（QDV）和脐静脉的血流量（QuV）,计算静脉导管（DV）分流率,测定胎儿升主动脉和肺动脉收缩期峰值速度（PFV）,测量一般径线包括胎儿的双顶径、头围、腹围、股骨长度,测量产后胎儿体重并进行Apgar评分。【结果]IUGR组脐动脉和腹主动脉的PI、RI及S／D测值明显比对照组增高,IUGR组大脑中动脉和颈内动脉的PI、RI及S／D测值比对照组低,IUGR组升主动脉和肺动脉的PFV明显低于对照组胎儿,差异具有统计学意义（P〈0．05）。两组胎儿的QDV无明显差异,但IUGR组的QuV显著下降且DV分流率显著升高,差异均有统计学意义（P〈0．05）。36周IUGR组的胎头双顶径（BPD）、胎儿头围（HC）、胎儿腹围（AC）和胎儿股骨长（FL）明显比对照组低,差异有统计学意义（P〈0．05）。【结论】超声通过综合监测胎儿血流动力学和一般径线的变化,可以全面、客观地评价胎儿生长发育情况。     

冠脉循环对左室舒张功能影响的研究

探讨心肌肥厚患者冠脉血流与左室舒张功能障碍各项指标的相关关系。方法采用经胸和经食管超声心动图技术,测量３０例心肌肥厚患者和１０例正常人冠状窦、二尖瓣及肺静脉血流频谱。结果与正常人相比,收肌肥厚患者冠状窦直径、前向血流和净前向血流流速积分明显增加,并且冠状窦前向血流和ＶＴＩｎｅｔ与左室舒张功能障碍的多项指标存在相关关系。     

Partial and total anomalous pulmonary venous connection in the fetus: two-dimensional and Doppler echocardiographic findings.

OBJECTIVE: Prenatal diagnosis of total (TAPVC) or partial (PAPVC) anomalous pulmonary venous connection in isolation or associated with other cardiac disease is important for appropriate prenatal counseling and perinatal management. We sought to assess the echocardiographic clues to the fetal diagnosis of TAPVC and PAPVC in a cohort of affected fetuses. METHODS: We retrospectively reviewed 29 fetal echocardiograms performed in 16 pregnancies with fetal TAPVC or PAPVC, systematically analyzing heart chamber size, presence of a confluence behind the left atrium or of a vertical vein, and Doppler flow patterns. RESULTS: Prenatal diagnosis was made at a mean gestational age of 27 +/- 7 weeks. TAPVC was found in 11 cases; five cases for each of supracardiac and infracardiac types and one mixed type. PAPVC was diagnosed in five fetuses, four of which had scimitar syndrome. Ten fetuses had an additional major cardiac defect, including hypoplastic left heart syndrome and right atrial isomerism. In three cases the prenatal diagnosis was only made at follow-up assessment. Among TAPVC cases, visualization of a confluence behind the left atrium (10/11) and a vertical vein (11/11) were the most consistent echocardiographic clues. Dextrocardia and a small right pulmonary artery suggested scimitar syndrome. The diagnosis was confirmed postnatally or at autopsy in 12 cases. In six fetuses with TAPVC and obstruction confirmed postnatally, continuous turbulent flow in the vertical vein and monophasic continuous flow in the pulmonary veins were demonstrated by color and spectral Doppler. CONCLUSIONS: Fetal echocardiography permits prenatal diagnosis of TAPVC or PAPVC. Spectral and color Doppler provide clues to the presence of an obstructed pulmonary venous pathway.