CAJ | 학술논문

目的：探讨胎儿二尖瓣环及三尖瓣环运动位移差值(瓣环位移差)对胎儿心功能定量研究的价值。方法选取455例孕20~41周正常胎儿,应用解剖 M 型超声心动图测量胎儿三尖瓣环位移(FAM-TAPSE)及二尖瓣环位移(FAM-MAPSE),并计算两者间差值。组织多普勒(TDI)分别测量二尖瓣环及三尖瓣环舒张早期峰值速度(Em 及 Em')和收缩期峰值速度(Sm 及 Sm')。随机选取中孕期及晚孕期共50例正常胎儿,采集标准四腔心观,输入 QLab 8.1工作站,分别选取右室游离壁三尖瓣环附着点、左室侧壁二尖瓣环附着点及心尖三点,同时获得二尖瓣环及三尖瓣环位移曲线图,比较二者位移曲线达峰时间的异同,并运用彩色追踪技术记录瓣环运动轨迹。结果各孕周 FAM-TAPSE 均大于 FAM-MAPSE,差异具有统计学意义(P <0.05)。胎儿瓣环位移差随孕周增加而逐渐增加,与孕周呈线性正相关；瓣环位移差与二尖瓣环 Em、Sm 及三尖瓣环 Em'、Sm'均呈显著正相关,瓣环运动曲线显示整个心动周期三尖瓣环位移值均大于二尖瓣环位移值,二者达峰时间差异无统计学意义(P >0.05)。结论瓣环位移差在胎儿中晚孕期持续存在,考虑与胎儿整体心室扭转有关,随孕周增加,瓣环位移差的增大还反映了胎儿心室扭转储备能力的增强。瓣环位移差能够定量反映胎儿心室整体的扭转及纵向运动,可作为评估胎儿心功能的另一新指标。
목적：탐토태인이첨판배급삼첨판배운동위이차치(판배위이차)대태인심공능정량연구적개치。방법선취455례잉20~41주정상태인,응용해부 M 형초성심동도측량태인삼첨판배위이(FAM-TAPSE)급이첨판배위이(FAM-MAPSE),병계산량자간차치。조직다보륵(TDI)분별측량이첨판배급삼첨판배서장조기봉치속도(Em 급 Em')화수축기봉치속도(Sm 급 Sm')。수궤선취중잉기급만잉기공50례정상태인,채집표준사강심관,수입 QLab 8.1공작참,분별선취우실유리벽삼첨판배부착점、좌실측벽이첨판배부착점급심첨삼점,동시획득이첨판배급삼첨판배위이곡선도,비교이자위이곡선체봉시간적이동,병운용채색추종기술기록판배운동궤적。결과각잉주 FAM-TAPSE 균대우 FAM-MAPSE,차이구유통계학의의(P <0.05)。태인판배위이차수잉주증가이축점증가,여잉주정선성정상관；판배위이차여이첨판배 Em、Sm 급삼첨판배 Em'、Sm'균정현저정상관,판배운동곡선현시정개심동주기삼첨판배위이치균대우이첨판배위이치,이자체봉시간차이무통계학의의(P >0.05)。결론판배위이차재태인중만잉기지속존재,고필여태인정체심실뉴전유관,수잉주증가,판배위이차적증대환반영료태인심실뉴전저비능력적증강。판배위이차능구정량반영태인심실정체적뉴전급종향운동,가작위평고태인심공능적령일신지표。
Objective To obtain the annular plane systolic excursion difference (APSED)of fetuses in second and late trimester by free angle M-mode (FAM)and tissue motion of annular displacement (TMAD)in order to assess the fetal ventricular function.Methods The mitral annular plane systolic excursion(MAPSE)and tricuspid annular plane systolic excursion(TAPSE)of four hundred and fifty five normal fetuses from 20 to 41 weeks were measured by FAM echocardiography,and the difference between them were calculated.Early diastolic velocities (Em)of the mitral annular and early diastolic velocities (Em')of the tricuspid annular were estimated by pulsed-wave tissue Doppler imaging (TDI),meanwhile systolic velocities (Sm)of the mitral annular and systolic velocities (Sm')of the tricuspid annular were also estimated by TDI.Fifty normal fetuses in the second and late trimester were choosed randomly,two-dimension imaging was obtained at the apical four-chamber view,then mitral annular plane and tricuspid annular plane displacement curve were acquired at the same time by using off-line QLab 8.1 software,and the differences in the peak time between them were compared.The trace of annular displacement were recorded by color tissue tracking technology.Results There was a significant difference between FAM-TAPSE and FAM-MAPSE in different gestational weeks (P <0.05),FAM-TAPSE was growing with the increase of gestational weeks,FAM-APSED showed significant positive correlations with gestational week, Em,Sm,Em' and Sm'.Annular plane displacement curve showed that TMAD-TAPSE was higher than TMAD-MAPSE in the entire cardiac cycle,and there was no statistically significant difference in time to peak of the annular plane displacement curve between them(P >0.05).Conclusions The APSED existed in the second and late trimester continually.It was considering associated with fetal ventricular torsion.As the growth of gestational weeks,the increase of APSED reflected the enhanced reserve capacity of the fetal ventricular torsion.APSED can reflect the longitudinal motion and torsion movement of fetal ventricle quantitatively,and can be used as a new index to assess the fetal cardiac function.