CAJ | 학술논문

目的：应用三维能量多普勒超声对比评价先天性心脏病胎儿和正常胎儿三大脑动脉区域血流灌注的差异。方法采集112例先天性心脏病胎儿和孕龄配对的112例正常胎儿的颅脑三维能量多普勒图像,采用虚拟器官计算机辅助分析(VOCAL)技术30°旋转法勾勒计算三大脑动脉区域,即大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA),计算并比较两组之间血流灌注参数血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI),评估血流灌注各参数与12月龄时贝利婴儿发育量表评分的相关性。结果与正常对照组相比较,三大脑动脉区 VI、FI 和 VFI 在左心发育不良综合征胎儿组和左心梗阻胎儿组明显增加(P <0.001),大脑前动脉区 VI、FI 和 VFI 在大动脉转位胎儿组明显增加(P <0.001),右心梗阻胎儿与正常胎儿之间各血流灌注参数无明显差异(P >0.05)。12月龄时,先心病组精神运动发展指数(PDI)和智力发育指数(MDI)均明显低于正常组(P <0.001)。ACA-VI、ACA-FI 与 PDI 均呈正相关(分别为 r =0.377,P =0.015和 r =0.389,P =0.012),但与 MDI 无明显相关性(P >0.05)。结论左心发育不良综合征和左心梗阻胎儿三大脑动脉区域血流灌注明显增加,大动脉转位胎儿大脑前动脉区血流灌注明显增加。ACA 区域血流灌注参数与婴儿智力发育评分有正相关性。产前应用三维能量多普勒能更早更敏感地评价先心病胎儿局部脑血流灌注,有利于产前咨询和产后及早神经保护干预。
목적：응용삼유능량다보륵초성대비평개선천성심장병태인화정상태인삼대뇌동맥구역혈류관주적차이。방법채집112례선천성심장병태인화잉령배대적112례정상태인적로뇌삼유능량다보륵도상,채용허의기관계산궤보조분석(VOCAL)기술30°선전법구륵계산삼대뇌동맥구역,즉대뇌전동맥(ACA)、대뇌중동맥(MCA)화대뇌후동맥(PCA),계산병비교량조지간혈류관주삼수혈관화지수(VI)、혈류지수(FI)화혈관화혈류지수(VFI),평고혈류관주각삼수여12월령시패리영인발육량표평분적상관성。결과여정상대조조상비교,삼대뇌동맥구 VI、FI 화 VFI 재좌심발육불량종합정태인조화좌심경조태인조명현증가(P <0.001),대뇌전동맥구 VI、FI 화 VFI 재대동맥전위태인조명현증가(P <0.001),우심경조태인여정상태인지간각혈류관주삼수무명현차이(P >0.05)。12월령시,선심병조정신운동발전지수(PDI)화지력발육지수(MDI)균명현저우정상조(P <0.001)。ACA-VI、ACA-FI 여 PDI 균정정상관(분별위 r =0.377,P =0.015화 r =0.389,P =0.012),단여 MDI 무명현상관성(P >0.05)。결론좌심발육불량종합정화좌심경조태인삼대뇌동맥구역혈류관주명현증가,대동맥전위태인대뇌전동맥구혈류관주명현증가。ACA 구역혈류관주삼수여영인지력발육평분유정상관성。산전응용삼유능량다보륵능경조경민감지평개선심병태인국부뇌혈류관주,유리우산전자순화산후급조신경보호간예。
Objective To investigate the regional cerebral blood flow perfusion in fetuses with congenital heart disease (CHD)by three-dimensional power Doppler ultrasound (3D PD).Methods The vascular index (VI),flow index (FI)and vascular/flow index (VFI)in the main arterial territories [middle cerebral artery (MCA ),anterior cerebral artery (ACA ) and posterior cerebral artery (PCA )] were prospectively compared in 1 12 fetuses with CHD and 1 12 normal fetuses using 3D PD.Correlations between the 3D PD indices and neurodevelopment scores were assessed.Results Compared with the controls,the VI,FI and VFI of the three main arteries were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS)and left sided obstructive lesions (LSOL)(P < 0.001 ).The mean psychomotor development index (PDI)and mental development index (MDI)scores were significantly lower than normal (P <0.001).ACA VI and ACA VFI were positively correlated with PDI (r =0.377,P =0.01 5 and r =0.389,P = 0.012,respectively)but were not correlated with MDI.Conclusions Cerebral blood flow perfusion in three main arteries was significantly increased in fetuses with HLHS/LSOL,and blood flow perfusion in ACA area was significantly increased in fetuses with TGA.ACA-VI,ACA-FI had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.