CAJ | 학술논문

目的：应用三维能量多普勒超声对比先天性心脏病胎儿和正常胎儿全脑血流灌注的差异,并评价全脑血流灌注各参数与生后12月龄时婴儿智力发育的相关性。方法采集112例先心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°旋转法勾勒计算全脑感兴趣区,计算并比较两组之间全脑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),评估全脑血流灌注各参数与生后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,全脑 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),余先心病组胎儿与正常胎儿之间差异无统计学意义(P >0.05)。生后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)。FI 与 PDI、MDI均呈正相关(PDI：r =0.342,P =0.029；MDI：r =0.339,P =0.030)。结论先心病胎儿全脑血流灌注明显增加,特别是左心发育不良综合征和左心梗阻胎儿,而且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评价先心病胎儿全脑血流灌注有利于产前咨询和产后及早神经保护干预。
목적：응용삼유능량다보륵초성대비선천성심장병태인화정상태인전뇌혈류관주적차이,병평개전뇌혈류관주각삼수여생후12월령시영인지력발육적상관성。방법채집112례선심병태인화잉령배대적112례정상태인적로뇌삼유능량다보륵도상,채용허의기관계산궤보조분석(VOCAL)기술30°선전법구륵계산전뇌감흥취구,계산병비교량조지간전뇌혈류관주삼수혈관화지수(VI)、혈류지수(FI)화혈관화혈류지수(VFI),평고전뇌혈류관주각삼수여생후12월령시패리영인발육량표평분적상관성。결과여정상대조조상비교,전뇌 VI、FI 화 VFI 재좌심발육불량종합정태인조화좌심경조태인조명현증가(P <0.001),여선심병조태인여정상태인지간차이무통계학의의(P >0.05)。생후12월령시,선심병조정신운동발전지수(PDI)화지력발육지수(MDI)균명현저우정상조(P <0.001)。FI 여 PDI、MDI균정정상관(PDI：r =0.342,P =0.029；MDI：r =0.339,P =0.030)。결론선심병태인전뇌혈류관주명현증가,특별시좌심발육불량종합정화좌심경조태인,이차여영인지력발육평분유정상관성。산전응용삼유능량다보륵평개선심병태인전뇌혈류관주유리우산전자순화산후급조신경보호간예。
Objective To investigate global 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 global cerebral 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 global brain were significantly increased in fetuses with hypoplastic left heart syndrome (HLHS) and left sided obstructive lesions (LSOLs)(P <0.001).The mean psychomotor development index (PDI) and mental development index (MDI)scores were significantly lower than normal (P < 0.001 ).FI was positively correlated with PDI (r =0.342,P =0.029)and MDI (r =0.339,P =0.030).Conclusions Global cerebral blood flow perfusion was significantly increased in most fetuses with CHD and had association with neurodevelopment scores.3D PD ultrasound might help to identify cases of brain vasodilatation earlier and inform parental counseling.