组织多普勒Tei指数评价三尖瓣返流胎儿右室功能的变化

目的采用组织多普勒Tei指数评价不同程度单纯三尖瓣返流胎儿的右室功能的变化。方法选取经胎儿超声心动图筛查为单纯三尖瓣返流的中晚孕胎儿60例（除外心内及其他部位结构性畸形），其中轻度返流36例，中度返流24例，另选取其他30例相同孕周不合并三尖瓣返流胎儿为对照，采用组织多普勒技术分别测定各胎儿的右室Tel指数，比较各组间胎儿右室Tei指数的变化情况，并观察其转归。结果轻度三尖瓣返流组右室Tei指数与正常对照组相比差异无统计学意义（P〉0．05）；出生后6周复查4例仍存在三尖瓣轻度返流，肺动脉收缩压19—27mmHg。中度三尖瓣返流组右室Tei指数与正常组及轻度返流组相比均升高（P均〈0．05），其中1例因孕晚期出现胸腹腔积液引产，余出生后6周复查7例合并中度三尖瓣返流，肺动脉收缩压30—45mmHg，12例合并轻度三尖瓣返流肺动脉收缩压27—36mmHg。结论轻度三尖瓣返流不影响胎儿右室功能，出生后转归良好；中度三尖瓣返流胎儿右室Tei指数升高，右室功能下降，部分转归较差，组织多普勒Tel指数能简便、快捷的评价合并三尖瓣返流胎儿右室整体功能的变化，为临床干预提供指导。

Evaluation on tright ventricular function of fetal with tricuspid regurgitation by Tissue Doppler Tei index

Objective To evaluate the right ventricular function of the fetal with tricuspid regurgitation by tissue Doppler Tel index. Methods Sixty fetal were diagnosed as isolated tricuspid regurgitation by fetal echoeardiography（ except those with structural defect in heart and other parts）. There were thirty - six cases of mild tricuspid regurgitation, and twenty - four cases of moderate tricuspid regurgitation. Thirty normal fetal during the second - third trimester without tricuspid re- gurgitation were chosen as controls. The right ventricular Tel index was measured by tissue Doppler technique. Observed the prognosis of each fetal. Results The right ventricular Tel index were no significant difference between the mild and moderate tricuspid regurgitation groups （P 〉 0. 05 ）. In mild tricuspid regurgitation groups, there were four infants still with mild tricuspid regurgitation 6 weeks after birth, and the pulmonary artery systolic pressure（PASP） were between 19 - 27mmHg. Compared with the normal and the mild tricuspid regurgitation group ,the right ventricular Tel index in mod- erate tricuspid regurgitation group were significantly higher （P 〈 0. 05 ）. one of the mild tricuspid regurgitation chose to labor induction because of ascites and pleural effusion. Six weeks after birth, there were seven infants with moderate tri- cuspid regurgitation, and the PASP were between 30 - 45mmHg, twelve infants with mild tricuspid regurgitation, the PASP were between 27 - 36mmHg. Conclusion Mild tricuspid regurgitation does not damage the fetal right ventricular func- tion, and will have favorable prognosis. But moderate tricuspid regurgitation can damage the fetal right ventricular func- tion,the right ventricular Tel index increases,and some of them have poor prognosis. The tissue Doppler Tel index can estimate the global fetal right ventricular function simply and accurately, guide the clinical intervention.