CAJ | 학술논문

目的：采用彩色多普勒超声评价孕中晚期正常胎儿静脉频谱形态和血流动力学变化，探讨其与胎儿右心功能的相关性。方法收集2013年7月至2014年7月于本院产检的500例健康孕妇彩色多普勒超声检查数据，记录并总结不同孕周胎儿腔静脉血流情况和三尖瓣瓣口血流速度，分析腔静脉频谱峰值、三尖瓣血流频谱与孕周的相关性。结果胎儿上、下腔静脉内径及显示长度与孕周呈正相关（P＜0.01）；S波、D波及A波流速均随孕周的增大而增加（P＜0.05）；下腔静脉与上腔静脉血流频谱形态相似，但方向相反，下腔静脉血流速度略高于上腔静脉；孕中晚期正常胎儿三尖瓣瓣口血流速度E峰＜A峰，E峰血流速度随孕周增加而增大，而A峰血流速度变化不明显，E/A值与孕周呈正相关（P＜0.01）；三尖瓣瓣环Ea值随孕周增加而增加，呈线性正相关（P＜0.01）；上腔静脉D波速度与三尖瓣E峰、Ea峰呈正相关，A波速度与三尖瓣A峰值呈正相关，上腔静脉D/A与三尖瓣E/A值呈正相关，下腔静脉D波速度与三尖瓣E峰、Ea峰呈正相关，A波速度与三尖瓣A峰值呈正相关，下腔静脉D/A与三尖瓣E/A值呈正相关，下腔静脉与右心功能参数的相关趋势同上腔静脉（P＜0.01）。结论彩色多普勒超声观察孕中晚期正常胎儿腔静脉血流情况，可进一步判断其右心功能，胎儿腔静脉可伴随孕周增加发生血流动力学变化，腔静脉内径与血流速度也随之增加，在评价正常胎儿右心功能方面具有一定科学性，但右心功能异常评价指标尚未明确，需进一步研究。
목적：채용채색다보륵초성평개잉중만기정상태인정맥빈보형태화혈류동역학변화，탐토기여태인우심공능적상관성。방법수집2013년7월지2014년7월우본원산검적500례건강잉부채색다보륵초성검사수거，기록병총결불동잉주태인강정맥혈류정황화삼첨판판구혈류속도，분석강정맥빈보봉치、삼첨판혈류빈보여잉주적상관성。결과태인상、하강정맥내경급현시장도여잉주정정상관（P＜0.01）；S파、D파급A파류속균수잉주적증대이증가（P＜0.05）；하강정맥여상강정맥혈류빈보형태상사，단방향상반，하강정맥혈류속도략고우상강정맥；잉중만기정상태인삼첨판판구혈류속도E봉＜A봉，E봉혈류속도수잉주증가이증대，이A봉혈류속도변화불명현，E/A치여잉주정정상관（P＜0.01）；삼첨판판배Ea치수잉주증가이증가，정선성정상관（P＜0.01）；상강정맥D파속도여삼첨판E봉、Ea봉정정상관，A파속도여삼첨판A봉치정정상관，상강정맥D/A여삼첨판E/A치정정상관，하강정맥D파속도여삼첨판E봉、Ea봉정정상관，A파속도여삼첨판A봉치정정상관，하강정맥D/A여삼첨판E/A치정정상관，하강정맥여우심공능삼수적상관추세동상강정맥（P＜0.01）。결론채색다보륵초성관찰잉중만기정상태인강정맥혈류정황，가진일보판단기우심공능，태인강정맥가반수잉주증가발생혈류동역학변화，강정맥내경여혈류속도야수지증가，재평개정상태인우심공능방면구유일정과학성，단우심공능이상평개지표상미명학，수진일보연구。
ObjectiveTo evaluate ultrasonic spectrum of vena cava and haemodynamic alteration of the normal fetus of middle-late pregnancy by ultrasonic Doppler detector and explore the relationship between these indexes with right cardiac function.MethodData of 500 cases of healthy pregnant women received color Doppler ultrasound scanning from July 2013 to July 2014 in our hospital were collected. Different gestational fetus venous blood flow situation and tricuspid valve blood flow velocity were recorded and summarized. The correlation between peak value of vena cava spectrum, tricuspid valve lfow spectrum and gestational age were compared.ResultFetus superior and inferior vena cava diameter and display length were positively correlated with gestational age (P<0.01); lfow velocity of S, D and A wave increases with gestational age (P<0.05); blood spectrum morphology of inferior vena cava was similar with superior vena cava, while, in the opposite direction. The lfow velocity of inferior vena cava was slightly higher than superior vena cava. E peak of tricuspid lfow velocity was lower than A peak in normal middle-late pregnancy fetus. Flow velocity of E peak increased with gestational age, while that of A peak didn’t obviously change. Thus the E/A ratio was positively correlated with gestational age (P<0.01); tissue Doppler image showed that Ea values of tricuspid ring increase along with gestational age, with a linear positive correlation (P<0.01); D wave velocity, Ea and tricuspid E peak superior vena cava were positively correlated. A wave velocity was positively related with tricuspid A peak. Superior vena cava D/A and tricuspid E/A ratio were positively correlated (P<0.01). And so was the inferior vena cava.ConclusionObservation of the blood lfow in fetus vena cava by Doppler imaging can further judge the right cardiac function. Hemodynamic changes of fetal vena cava associated with gestational age, along with the increase of vena cava diameter and blood lfow velocity. It shows some potential in evaluating the right cardiac function of normal fetus. However, further research needs to be done to ifnd a proper index to detect abnormal the right cardiac function.