二维彩色多普勒技术用于胎儿静脉导管血流频谱观察中的临床价值

目的研究二维彩色多普勒技术用于胎儿静脉导管血流频谱观察中的临床价值。方法回归性分析我院2013年8月至2015年12月中晚孕期正常胎儿90例和36例先天性心脏病胎儿,比较正常胎儿和先天性心脏病胎儿阻力指数(RI)、静脉搏动指数(PI)、静脉前负荷指数(PLI)、心室收缩峰期流速/心房收缩谷流速(S/A),比较两组胎儿心室收缩期峰值速度(Vs)、心室收缩末期流速(Ves)、心室舒张期峰值速度(Vd)、心房收缩期流速(Va)、平均时间最大流速(TAMXV),分析静脉导管血流频谱与胎儿先天性心脏病的关系。结果正常胎儿组RI(0.46±0.14)、PI(0.70±0.21)、PLI(0.44±0.20)、S/A(2.02±0.52)指数较先天性心脏病胎儿组(0.62±0.18)、(0.87±0.38)、(0.68±0.31)、(5.36±0.25)显著较低(P0.05);正常胎儿组的Vs(78.26±18.07)cm/s、Ves(51.95±14.94)cm/s、Vd(63.55±18.36)cm/s、Va(44.49±14.96)cm/s、TAMXV(61.97±16.82)cm/s等静脉导管血流速度指标水平较先天性心脏病胎儿组(56.45±12.62)cm/s、(37.18±9.26)cm/s、(42.29±10.51)cm/s、(22.62±6.58)cm/s、(37.19±8.18)cm/s、显著较高(P0.05);静脉导管多普勒血流频谱对先天性心脏病检测的敏感性为91.67%,特异性为83.33%,准确性为85.71%。结论患有先天性心脏病的胎儿血流速度慢于正常值,各项静脉血流参数高于正常胎儿,二维彩色多普勒频谱对先天性心脏病胎儿的检测准确率高,有临床上价值。

The Clinical Value of two Dimensional Color Doppler Technique in the Observation of Blood flow Spectrum of Fetal Venous Duct

Objective To study the clinical value of two-dimensional color Doppler technique in the observation of blood flow spectrum of fetal venous duct.Methods 90 cases of normal fetuses in advanced pregnant period and 36 cases of fetuses with congenital heart disease who were admitted in our hospital between December 2011 and December 2013 were analyzed.The resistance index (RI),venous pulsatility index(PI),venous preload index(PLI) and ventricular systolic peak velocity/atrial systolic peak velocity(S/ A)were compared between normal fetuses and fetuses with congenital heart disease.The ventricular systolic peak velocity(Vs),ventricular end systolic velocity (Ves),ventricular diastolic peak velocity (Vd),atrial systolic velocity(Va) and time averaged maximum velocity(TAMXV)were compared bwtween the two groups of fetuses.The relationship between blood flow spectrum of venous duct and fetal congenital heart disease was analyzed.Results The RI(0.46 ± 0.14),PI (0.70 ± 0.21),PLI (0.44 ± 0.20) and S/A (2.02 ± 0.52) in normal fetus group were significantly lower than those in congenital heart disease group [(0.62 ± 0.18),(0.87 ±0.38),(0.68 ±0.31),(5.36 ±0.25)] (P ＜0.05);The levels of blood velocity indexes of venosus duct such as Vs(78.26 ± 18.07)cm/s,Ves(51.95 ± 14.94) cm/s,Vd(63.55 ± 18.36)cm/s,Va(44.49 ± 14.96) cm/s and TAMXV(61.97 ± 16.82)cm/s in normal fetus group were significantly higher than those in congenital heart disease group [(56.45 ± 12.62) er/s,(37.18 ± 9.26) cm/ s,(42.29 ± 10.51) cm/s,(22.62 ± 6.58) cm/s,(37.19 ± 8.18) cm/s] (P ＜ 0.05);The sensitivity of venous duct Doppler blood flow spectrum in the detection of congenital heart disease was 91.67％,specificity was 83.33％ and accuracy was 85.71％.Conclusion The blood flow velocity of fetuses with congenital heart disease is slower than the normal value,and the venous blood flow parameters are higher than those of normal fetuses.The accuracy of two-dimensional color Doppler spectrum in detection of fetuses with congenital heart disease is high.It should be applied and promoted in clinic.