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目的 探讨彩色多普勒超声技术诊断胎儿充血性心衰 (CHF) ,为早期宫内诊断和治疗及疗效评价提供准确依据。方法 经我院检出并诊断 2 3例 CHF胎儿及正常对照组 30例。结果 (1)其中 11例出现中度以上水肿。 (2 )均示心脏显著肥厚扩大 ,表现为心胸比例增大 ,心房、心室的不对称及心室壁肥厚 ;心室缩短率 (FS% )及心输出量 (CCO)降低 (P<0 .0 0 1)。 (3)进行性加重的二、三尖瓣返流 (MR TR) ,5例肺动脉瓣返流。 (4 ) 2 3例胎儿脐动脉 PI值明显增高或舒张期血流相消失及大脑中动脉 PI值降低 ;13例出现脐静脉搏动性血流 ,下腔静脉内径增宽及血流频谱改变。结论 应用多普勒超声心动图通过主动脉和肺动脉 CO的总和 CCO可无创获得心输出量的指标及计算 FS以达到量化胎儿心功能的目的 ,加之可直观地显示胎儿心脏结构 ,检测瓣膜返流及评价外周血流动力学变化。
Objective To investigate the diagnostic value of color Doppler ultrasound in the diagnosis of fetal congestive heart failure (CHF), providing an accurate basis for the early intrauterine diagnosis and treatment and evaluation of the curative effect. Methods Twenty-three CHF fetuses and 30 normal controls were detected and diagnosed in our hospital. Results (1) Eleven of them showed moderate or severe edema. (2) showed significant enlargement of cardiac hypertrophy, manifested as increased proportion of the heart and chest, atrial and ventricular asymmetry and ventricular wall hypertrophy; reduced ventricular rate (F%) and cardiac output (CCO) decreased (P <0 0 0 1). (3) progressive two tricuspid regurgitation (MR TR), 5 cases of pulmonary valve regurgitation. (4) The PI of fetus umbilical artery was significantly increased or the diastolic blood flow disappeared and the PI value of the middle cerebral artery decreased in 23 cases. Pulmonary umbilical pulsatile blood flow, widened inferior vena cava diameter and changes of blood flow spectrum were found in 13 cases. Conclusion Doppler echocardiography through the aorta and pulmonary artery CO total CCO noninvasively obtained cardiac output index and calculate FS in order to quantify the purpose of fetal heart function, combined with the visual display of fetal heart structure, detection of valve regurgitation And evaluate peripheral hemodynamic changes.