时间-空间关联成像技术比较脐动脉舒张末期血流缺失胎儿与正常胎儿心功能的临床研究

目的 时间-空间关联成像技术分析比较脐动脉舒张末期血流缺失胎儿与正常胎儿心功能变化，探讨临床价值。方法 采用时间-空间关联成像技术（STIC）检测孕26~30周常规B超检查发现脐动脉舒张末期血流缺失的26例胎儿与同孕期103例脐血流正常胎儿，获取胎儿心动周期容积数据，应用虚拟器官计算机辅助分析软件（VOCAL）脱机分析比较脐动脉舒张末期血流缺失研究组胎儿与正常对照组胎儿，左、右心室功能变化，包括舒张末容积（EDV）、收缩末容积（ESV）、每搏排出量（SV）、心排出量（CO）、射血分数（EF）、及胎儿各生长径线校正心排出量对比。结果 在平均左、右心室舒张末容积、收缩末容积、每搏排出量、心排出量、校正心排出量，研究组比对照组明显减小。在平均射血分数方面，研究组比对照组明显增加。研究组内左、右心室指标比较，在平均心室舒张末容积、收缩末容积、每搏排出量、心排出量、校正心排出量，左心室减小率明显高于右心室。在平均射血分数方面，左心室增加率高于右心室，差异有统计学意义（P<0.05）。结论 心功能代偿不足预示亚临床心力衰竭风险。时间-空间关联成像技术分析心功能，对临床治疗效果评判和决定终止妊娠时机有一定临床价值。

A Study on Cardiac Function of Fetus with Absent End-diastolic Velocity in Umbilical Artery and Normal Fetus Using Spatiotemporal Image Correlation

Objective To evaluate the cardiac function of fetus with absent end-diastolic velocity in umbilical artery and normal fetus, using spatiotemporal image correlation (STIC), and also to explore the clinical potential of this examination. Methods By STIC technique, cardiac cycle ventricular volume parameters were recorded, including 26 fetus screened by conventional sonography as absent end-diastolic velocity in umbilical artery, and 103 normal fetus within the same range of gestational weeks. Using virtual organ computer-aided analysis (VOCAL), the current study assessed both fetal left and right ventricular cardiac function of the study group with absent end-diastolic velocity in umbilical artery, and the control group, involving ventricular end-diastole volume (EDV), end-systole volume (ESV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and cardiac output adjusted by fetal biometric parameters. Results In mean left and right ventricular EDV, ESV, SV, CO, and adjusted CO, the study group was significantly lower than the control group. In mean EF, the study group was significantly higher than the control group. Within the study group, the decreasing proportion of left ventricle was significantly higher than right ventricle, in mean EDV, ESV, SV, CO, and adjusted CO. While in mean EF, the increasing proportion of left ventricle was significantly higher than right ventricle. Conclusion Insufficient compensation of cardiac function can suggest the risk of subclinical cardiac failure. Spatiotemporal image correlation technique can be adjuvant means in evaluating therapeutic effect, and in decision on termination of pregnancy.