孕中期左心发育不良综合征胎儿的肺动脉血流参数特征的价值

doi:10.3877/cma.j.issn.1672-6448.2019.05.015

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (05) : 375 -379. doi: 10.3877/cma.j.issn.1672-6448.2019.05.015

所属专题：妇产科超声影像学；文献；妇产科超声；

妇产科超声影像学

孕中期左心发育不良综合征胎儿的肺动脉血流参数特征的价值

陈小敏¹, 邓学东¹^,^†(

), 苟中山¹, 杨忠¹, 梁泓¹

^1. 215002　南京医科大学附属苏州医院　苏州市立医院超声中心

收稿日期:2017-12-14 出版日期:2019-05-01
通信作者: 邓学东

Characteristics of branch pulmonary artery flow patterns in fetuses with left heart hypoplasia syndrome in the second trimester

Xiaomin Chen¹, Xuedong Deng¹^,^†(), Zhongshan Gou¹, Zhong Yang¹, Hong Liang¹

^1. Center for Medical Ultrasound, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China

Received:2017-12-14 Published:2019-05-01
Corresponding author: Xuedong Deng
About author:
Corresponding author: Deng Xuedong, Email: xuedongdeng@163.com

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目的

探讨孕中期左心发育不良综合征（HLHS）胎儿肺动脉血流参数特征。

方法

选取2015年8月至2017年5月在南京医科大学附属苏州医院确诊HLHS胎儿54例，将中孕期HLHS胎儿按照其房间隔血流模式分为血流通畅组（41例）与梗阻组（13例），并与正常胎儿（健康对照组，55例）在肺动脉主干内径、右肺动脉内径和右肺动脉第一级分支血流频谱参数3个层面进行对比，采用LSD-t检验分析通畅型和梗阻型HLHS胎儿的肺动脉内径、收缩期峰值流速（PSV）、舒张期末期速度（EDV）、平均速度（TAMXV）、速度-时间积分（VTI）和肺动脉搏动指数（PA PI）等血流参数特征。

结果

肺动脉主干内径方面，三组间均值比较（5.4±0.6 vs 6.7±0.8 vs 6.8±0.9），差异有统计学意义（F=198.56，P<0.05），且通畅组和梗阻组的肺主干内径均大于健康对照组，差异均有统计学意义（t=-18.501、-13.97，P均<0.05），而通畅组和梗阻组的均值比较，差异无统计学意义（P=0.85）；右肺动脉内径方面，三组间均值比较，差异无统计学意义（P=0.59）；右肺动脉第一级分支血流频谱参数方面，三组间在PSV比较，差异无统计学意义（P=0.34），而在EDV、TAMXV、VTI和PA PI方面，差异均有统计学意义（F=62.98、38.45、13.19及12.46，P均<0.05），且通畅组和梗阻组胎儿EDV、TAMXV和VTI均值小于健康对照组，差异均有统计学意义（t=4.273和10.353、3.546和7.978、-0.441和5.418，P均<0.05），且梗阻组均值小于通畅组，差异均有统计学意义（t=5.542、7.033及4.098，P均<0.05）；而通畅组和梗阻组HLHS胎儿PA PI均值大于健康对照组，差异均有统计学意义（t=-2.638、-6.474，P均<0.05），且梗阻组大于通畅组，差异均有统计学意义（t=-2.541，P<0.05）。

结论

HLHS胎儿肺动脉分支血流前向阻力增加，且房间隔血流梗阻型相对于通畅型表现更为显著，这可能与梗阻型肺血管床受损程度相对较重有关。

关键词: 左心系统发育不良综合征, 肺动脉分支, 血流模式

Objective

To explore the characteristics of branch pulmonary artery flow patterns in fetuses with left heart hypoplasia syndrome (HLHS).

Methods

HLHS fetuses were divided into an unobstructed group and an obstructed group according to the blood flow pattern across the interatrial septum. Main pulmonary artery diameter, right pulmonary artery diameter, and Doppler parameters of first-order right pulmonary artery of both groups were measured by fetal echocardiography and compared with those of normal controls.

Results

There was a significant difference in the diameter of pulmonary trunk among different the three groups (F=198.56, P<0.05), and the main pulmonary artery diameter in the two groups of HLHS fetuses were larger than that in normal controls (t=-18.501, -13.97, P<0.05), but there was no significant difference between the two groups of HLHS fetuses (P=0.85). There was no significant difference in right pulmonary artery diameter among the three groups (P=0.59). The end-diastolic velocity, time-averaged maximum velocity, and velocity-time integral in the two HLHS groups were lower than those in normal controls, and these parameters in the obstructed group were less than those in the unobstructed group. The pulmonary artery pulsatility index in the two HLHS groups was higher than those in normal controls, and it was higher in the obstructed group than in the unobstructed group. There was no statistically significant difference in peak systolic velocity among the three groups (P=0.34).

Conclusion

The antegrade resistance of the pulmonary arteries of HLHS fetuses increase and these pathologcial conditions are more obvious in those with obstructed flow across the atrial septum compared to those with unobstructed flow.

Key words: Left heart hypoplasia syndrome, Branch pulmonary artery, Flow pattern

图1~3 右肺动脉第一级分支频谱多普勒参数测量。图1健康对照组胎儿舒张期频谱明亮、平缓；图2通畅型HLHS胎儿舒张期频谱暗淡、低平；图3而梗阻型舒张期频谱部分微弱、缺失

表1 健康对照组、通畅组、梗阻组孕中期左心发育不良综合征胎儿肺动脉内径和右肺动脉第一级分支频谱多普勒参数均值比较（±s）

组别	例数	PA（mm）	RPA（mm）	PSV（cm/s）	EDV（cm/s）	TAMXV（cm/s）	PA PI	VTI
健康对照组	55	5.4±0.6	2.5±0.3	71.7±19.7	3.3±0.4	18.1±2.9	3.4±0.9	7.3±1.2
通畅组	41	6.7±0.8^a	2.6±0.3	70.9±20.7	2.6±0.5^a	16.1±2.9^a	4.3±1.3^a	6.8±1.4^a
梗阻组	13	6.8±0.9^b	2.6±0.2	71.1±19.3	1.5±0.5^bc	13.8±3.1^bc	5.0±1.2^bc	5.7±1.3^bc
F值	?	198.56	0.54	1.08	62.98	38.45	13.19	12.46
P值	?	<0.001	0.59	0.34	<0.001	<0.001	<0.001	<0.001

表1 健康对照组、通畅组、梗阻组孕中期左心发育不良综合征胎儿肺动脉内径和右肺动脉第一级分支频谱多普勒参数均值比较（±s）

组别	例数	PA（mm）	RPA（mm）	PSV（cm/s）	EDV（cm/s）	TAMXV（cm/s）	PA PI	VTI
健康对照组	55	5.4±0.6	2.5±0.3	71.7±19.7	3.3±0.4	18.1±2.9	3.4±0.9	7.3±1.2
通畅组	41	6.7±0.8^a	2.6±0.3	70.9±20.7	2.6±0.5^a	16.1±2.9^a	4.3±1.3^a	6.8±1.4^a
梗阻组	13	6.8±0.9^b	2.6±0.2	71.1±19.3	1.5±0.5^bc	13.8±3.1^bc	5.0±1.2^bc	5.7±1.3^bc
F值	?	198.56	0.54	1.08	62.98	38.45	13.19	12.46
P值	?	<0.001	0.59	0.34	<0.001	<0.001	<0.001	<0.001

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