定量组织多普勒Tei指数评价重度妊高征患者及胎儿心功能的研究

目的应用定量组织速度成像测量Tei指数评价重度妊高征患者及胎儿心功能的临床价值。方法测量52例重度妊高征患者和60例健康产妇常规超声心动图参数及二尖瓣环各部位收缩期、舒张早期及舒张晚期的峰值速度（Vs、Ve、Va），同时测量胎儿右室房室瓣环室壁运动的等容舒张时间（IRT）、等容收缩时间（ICT）和射血时间（ET），计算Tei指数。结果①重度妊高征组胎儿室间隔厚度、左室后壁厚度、心率和左房前后径较对照组增加，左室舒张末内径、左室射血分数和每搏射血分数两组间比较，差异无统计学意义。妊高征组二尖瓣口血流频谱E峰流速（rE）、A峰流速（VA）和左室等容舒张时间（IVRT）增加，VE／VA降低；②重度妊高征组二尖瓣环各位点组织速度Vs低于对照组，Ve除后间隔外均低于对照组，Va值除前间隔外均高于对照组；③重度妊高征组胎儿的IRT＋ICT和Tei指数高于对照组，ET高于对照组，但差异无统计学意义。结论定量组织速度成像对诊断重度妊高征引起的左心室收缩和舒张功能变化较为敏感，重度妊高征不仅会影响母体心脏功能，而且累及胎儿心脏功能。

Evaluation of heart function in patients with severe pregnancy induced hypertension and fetus by Tei index with quantitative tissue velocity imaging

Objective To investigate the clinical value of Tei index in assessment of heart function in patients with severe pregnancy induced hypertension（PIH） and fetus by quantitative tissue velocity imaging（QTVI）. Methods Fifty - two patients with severe PIH and Sixty healthy primiparas were examined by echocardiography, the peak velocity of the systolic phase, the peak velocity of early stage and advanced stage of diastolic phase at the mitral annulus （Vs, Ve, Va） were measured, and the Tei index of the right ventricle in fetus were calcuated simultaneously. Results ①The parameters of interventricular septum （IVS） ,left ventrieular posterior wall （LVPW）, heart rate （HR）and left atrial diameter （LAD）in severe PIH group increased more obviously than those in control group, but there was no significant difference of left ventricular diastolic diameter （LVDd）, left ventricular ejection fraction （LVEF） and strokevolume （SV） between the two groups. The velocity of E peak and A peak of the mitral flow （VE , VA） and the isovolumic relaxation time （IVRT） increased significantly in PIH group, but VE/ VA decreased. ②Vs in PIH group was lower than that in control group, and Ve was lower markedly except the posterior septum , and Va was higher except the anterior septum. ③Isovolumic relaxation time and isovolumic contraction time （ IRT ＋ ICT） and Tei index in PIH group were higher than those in control group, and ejection time （ET） was also higher than control group , but there was no significant difference between the two groups. Conclusion QTVI is sensitive to diagnose the change of the systolic and diastolic function of left ventricle in severe PIH with QTVI. Severe PIH affects not only the cardiac function of mother, but also that of fetus.