CAJ | 학술논문

目的探讨正常中晚期妊娠胎儿随孕周增长心排血量及其分布的变化情况,并得出相应参考值范围.方法对313例孕20～40周正常胎儿进行超声心动图检查,分别于左室流出道切面、右室流出道切面、三血管切面、主动脉弓纵切面测量主动脉瓣、肺动脉瓣、动脉导管、主动脉峡部的最大内径(D),取得各部位血流频谱并采用自动包络模式得到各自的速度时间积分(VTI)和心率(HR).根据公式Q=(D/2)2×3.14×VTI×HR计算左心室排血量、右心室排血量、动脉导管流量及主动脉峡部流量.结果正常中晚孕胎儿左心室排血量、右心室排血量、联合心输出量、主动脉峡部流量、动脉导管流量随着孕周的增加逐渐增加,与孕周呈线性正相关;主动脉峡部流量随胎儿体质量增长而增加,二者显著相关;主动脉峡部流量/动脉导管流量比值随孕周增长逐渐减小,与孕周呈线性负相关;主动脉峡部流量/左心室排血量及主动脉峡部流量/联合心输出量比值与孕周相关性差,相对恒定.结论建立胎儿心排血量及其分布的正常参考值范围可以提高对胎儿循环系统生理的认识,并有助于鉴别异常病理情况,特别是对因早期主动脉峡部血流量异常可能造成的后期形态学改变进行提示,对及早评估胎儿的风险值及进行密切的随访观察和采取必要有效的干预措施具有重要的临床价值.
목적 탐토정상중만기임신태인수잉주증장심배혈량급기분포적변화정황,병득출상응삼고치범위.방법 대313례잉20～40주정상태인진행초성심동도검사,분별우좌실류출도절면、우실류출도절면、삼혈관절면、주동맥궁종절면측량주동맥판、폐동맥판、동맥도관、주동맥협부적최대내경(D),취득각부위혈류빈보병채용자동포락모식득도각자적속도시간적분(VTI)화심솔(HR).근거공식Q=(D/2)2×3.14×VTI×HR계산좌심실배혈량、우심실배혈량、동맥도관류량급주동맥협부류량.결과 정상중만잉태인좌심실배혈량、우심실배혈량、연합심수출량、주동맥협부류량、동맥도관류량수착잉주적증가축점증가,여잉주정선성정상관;주동맥협부류량수태인체질량증장이증가,이자현저상관;주동맥협부류량/동맥도관류량비치수잉주증장축점감소,여잉주정선성부상관;주동맥협부류량/좌심실배혈량급주동맥협부류량/연합심수출량비치여잉주상관성차,상대항정.결론 건립태인심배혈량급기분포적정상삼고치범위가이제고대태인순배계통생리적인식,병유조우감별이상병리정황,특별시대인조기주동맥협부혈류량이상가능조성적후기형태학개변진행제시,대급조평고태인적풍험치급진행밀절적수방관찰화채취필요유효적간예조시구유중요적림상개치.
Objective To explore the changes of cardiac output and distribution with the increasing of pregnancy week in normal fetuses of middle and late pregnancy and establish the normal reference range.Methods Three hundred and thirteen normal fetuses in 20-40 pregnancy weeks underwent fetal echocardiography.The largest diameters of aortic valve,pulmonary valve,ductus arteriosus,aortic isthmus were measured respectively in the left ventricular outflow view,right ventricular outflow view,three vessels view and aortic arch longitudinal view.The blood flow spectrums of these parts were acquired and its velocity time integral (VTI) and heart rate (HR) were got by automatic envelope model.According to the formula of Q =(diameter/2)2 × 3.14 × VTI × HR,the cardiac output of left and right ventricle,the blood flow of aortic isthmus and ductus arteriosus were calculated.Results The cardiac outputs of left and right ventricle,combined cardiac output and the blood flow of aortic isthmus and ductus arteriosus of normal fetuses in middle and late pregnancy gradually increased with the increasing of gestational age and there were linear positive correlation between them.The blood flow of aortic isthmus increased with fetal weight,and there was significant correlation between them.The ratio of blood flow of aortic isthmus and ductus arteriosus decreased gradually with the increasing pregnancy week,and there was linear negative relationship between them.The ratio of blood flow of aortic isthmus and output of left ventricle and the ratio of blood flow of aortic isthmus and cardiac output were relatively constant,and there was poor correlation with gestational age.Conclusions Quantification of cardiac output and blood flow of AI can improve understanding about fetal circulation system physiology and help to identify abnormal pathological conditions,especially prompt the late morphological changes because of early abnormal flow of aortic isthmus.There was high clinical value for evaluating early fetal risk value and adopt necessary and effective intervention method.