多普勒超声检测胎儿心脏机械性PR间期的临床意义研究

目的应用多普勒超声技术测量胎儿心脏机械性PR间期并探讨其临床意义。方法选取经胎儿超声心动图检出的83例疾病组胎儿,分别为先天性心脏病及心律失常。正常对照组为100例中、晚孕胎儿。应用彩色多普勒引导脉冲多普勒取样容积记录左心室流入道及流出道血流频谱,测量从舒张期二尖瓣A峰起始至收缩期主动脉射血起始的心房到心室的传导时间(PR间期),并同时测量收缩期主动脉射血起始至二尖瓣A峰起始的时间(VA间期)。结果 83例疾病组胎儿中先天性心脏病69例,心律失常12例,双胎输血综合征1例(双胎儿)。其中54例多普勒超声测量PR间期延长(131～220ms),并检出自身免疫性抗体阳性和弱阳性5例。正常对照组100例的中、晚孕孕妇均无自身免疫系统疾病,并经超声排除胎儿先天性心脏病、心律失常及其他胎儿异常,多普勒超声测量PR间期值均≤130ms。两组PR间期、VA间期比较差异有统计学意义(P0.01)。结论本研究结果表明,除孕妇患自身免疫性疾病可引起胎儿传导系统受损外,胎儿患先天性心脏病、心律失常等疾病时,其窦房结、房室结传导功能的易损性明显高于正常胎儿。其影响因素与心脏解剖结构异常和传导系统发育不良的相关性有待进一步研究。

Clinical application of mechanical PR interval of Doppler ultrasound in fetal cardiac

Objective To explore the application of mechanical PR interval of Doppler ultrasound measurement in fetal heart, and to analyze the test results and the clinical significance of a group of abnormal fetuses. Methods A total of 83 cases of abnormal group detected by fetal echocardiography were classified as congenital heart disease and arrhythmia. The healthy control group consisted of 100 cases in medium-term and late gestation. The pulse Doppler sample volume guided by color Doppler recorded the blood flow spectrum of left ventricular inflow tract / outflow tract and measured the conduction time from the beginning of the diastolic mitral A peak to the beginning of aortic systolic ejection （PR interval） and from the beginning of aortic systolic ejection to the beginning of mitral A peak （VA interval）. Results The eighty-three cases of abnormal group（69 cases of congenital heart disease and 12 cases of arrhythmia）included 54 cases of Doppler ultrasound measurement of PR interval prolongation （131-220 ms）. One hundred cases of normal control group had no autoimmune disease, which was ruled out by ultrasound of fetal congenital heart disease, arrhythmia and other fetal anomalies, whose Doppler ultrasound measurement of PR interval value was not less than 130 ms. The comparison PR interval versus VA interval had the most significant discriminating power （P 〈 0.01 ）. Conclusion The results of this study showed the pregnant women suffering from auto- immune diseases can lead to damage of fetal conduction system. In addition, the vulnerability of sinus node and atrioventricular node in the fetuses of congenital heart disease, arrhythmiawas significantly higher than normal group. The relevance between their pathogenic factors with abnormal anatomical structure of the cardiac dysplasia conduction system should be further studied.