功能性单心室合并大动脉梗阻胎儿的脑血流改变

目的 探讨功能性单心室（FSV）合并大动脉梗阻胎儿的脑血流改变。方法 收集经超声心动图诊断为FSV的胎儿40胎（病例组），正常胎儿65胎（对照组）。采用脉冲多普勒超声检测胎儿大脑中动脉（MCA）和脐动脉（UA），计算MCA搏动指数（MCA-PI）、UA搏动指数（UA-PI）和脑/脐血管阻力指数比（CPR）。先将MCA-PI与UA-PI进行Z分数换算，再进行统计学分析。结果 病例组40胎FSV中，23胎FSV合并主动脉梗阻（FSV合并主动脉梗阻亚组），17胎FSV合并肺动脉梗阻（FSV合并肺动脉梗阻亚组）。病例组与对照组MCA-PI Z分数、UA-PI Z分数、CPR差异均无统计学意义（P>0.05）。FSV合并主动脉梗阻亚组MCA-PI Z分数值低于对照组及FSV合并肺动脉梗阻亚组（P<0.05）。FSV合并肺动脉梗阻亚组MCA-PI Z分数值高于对照组（P<0.05）。3组UA-PI Z分数值差异无统计学意义（P>0.05）。FSV合并主动脉梗阻亚组CPR值低于对照组及FSV合并肺动脉梗阻亚组（P<0.05），FSV合并肺动脉梗阻亚组CPR值与对照组差异无统计学意义（P>0.05）。结论 FSV合并主动脉梗阻和FSV合并肺动脉梗阻的胎儿脑血流改变不同，且存在不同程度的脑循环代偿反应。

Cerebral blood flow changes of fetuses with functional single-ventricle and main artery obstruction

Objective To investigate cerebral blood flow changes of fetuses with functional single-ventricle (FSV). Methods Forty cases FSV fetuses (case group) and 65 cases normal fetuses (control group) diagnosed by ultrasonic cardiogram were collected. Middle cerebral artery (MCA) and umbilical artery (UA) were detected by pulse Doppler ultrasound. MCA pulsatility index (MCA-PI), UA pulsatility index (UA-PI), cerebral-to-placental resistance ratio (CPR) were calculated. Z fraction of MCA-PI and UA-PI were converted and statistical analysis was carried out. Results Among 40 FSV fetuses, there were 23 fetuses combined with aorta obstruction (FSV and aorta obstruction subgroup), 17 fetuses with pulmonary artery obstruction (FSV and pulmonary artery obstruction subgroup). There was no statistically significant difference in Z fraction of MCA-PI and UA-PI, and CPR between case group and control group (all P>0.05). Z fraction of MCA-PI in FSV and aorta obstruction subgroup was smaller than those of FSV and pulmonary artery obstruction subgroup and control group (P<0.05). Z fraction of MCA-PI in FSV and pulmonary artery obstruction subgroup was bigger than that of control group (P<0.05). There was no significant difference of Z fraction of UA-PI among 3 groups (P>0.05). CPR in FSV and aorta obstruction subgroup was smaller than that of control group and FSV and pulmonary artery obstruction subgroup (P<0.05), and there was no significant difference of CPR in FSV and pulmonary artery obstruction subgroup and control group (P>0.05). Conclusion Cerebral blood flow changes are different in aorta obstruction and pulmonary artery obstruction of FSV fetuses, which has cerebral circulation compensatory response in different degree.