【作者】 贾莉；

【导师】 高晓军；

【作者基本信息】 大连医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:正常妊娠期孕妇心血管系统发生了诸如结构、功能及血流动力学等方面显著的适应性变化,超声心动图以其简便无创、准确价廉和重复性强的特性自70年代后期成为临床检测妊娠期母体心脏功能的重要手段之一。临床已有大量文献采用传统M型( M mode echocardiography,ME)、二维(two dimensional echocardiography,2DE)和频谱多普勒超声心动图评价妊娠期心脏结构及舒缩功能。实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)是近年来心脏超声成像领域的重大技术突破,全容积(full volume)成像作为其成像方式之一被应用于评价正常妊娠心脏功能的研究国内外鲜见报道。本研究旨在探讨新技术全容积三维超声心动图( full volume three-dimensional echocardiography,FV-3DE)在健康孕妇左心功能早期定量中的应用价值。方法:采用FV-3DE、常规超声心动图对52例健康孕妇(包括早孕组15例、中孕组18例、晚孕组19例)及年龄匹配的20例健康未孕妇女(对照组)左心进行检测,对比分析随妊娠进展健康孕妇组及对照组FV-3DE左心房功能(左房最大容积LAVmax、左房最小容积LAVmin、左房射血量LASV、左房总体射血分数LAEF)、左心室质量(左心室心肌质量LVM、左心室心肌质量指数LVMI)、左心室功能(左室舒张末容积LVEDV、左室收缩末容积LVESV、左室每搏量LVSV、左室射血分数LVEF、左室心输出量LVCO、左室心排指数LVCI、峰值射血率PER、峰值充盈率PFR)及常规超声心动图左心结构、功能等参数(左室舒张末内径LVEDd、室间隔舒张末厚度IVSd、左室后壁舒张末厚度LVPWd、左房收缩末前后径LAs;二尖瓣舒张早期最大峰速E、舒张晚期最大峰速A及E/A比值)的变化,同时对受检者平均压(MBP)及总外周阻力(TPR)等血流动力学指标进行分析。结果:FV-3DE图像满意率分别为:对照组及早孕组100%、中孕组88.9%(16/18)、晚孕组78.9%(15/19)。健康孕妇循环系统处于高流低阻血流动力学状态,TPR孕早期开始降低,随孕期逐级递减至孕晚期最低,组间有显著统计学差异(P<0.01);整个妊娠期MBP无明显变化(P>0.05)。妊娠期健康孕妇心血管系统因循环血量增多及长期慢性超负荷作用发生重构,表现在:伴随妊娠进展,健康孕妇左心房室内径及容积(LAs、LVEDd、LAVmax、LAVmin、LVEDV、LVESV)、射血量或每搏量(LASV、LVSV)、心输出量(LVCO)及心排指数(LVCI)均呈现逐步升高的趋势,至孕晚期达最大,组间差异均有统计学意义(P<0.05、P<0.01或P<0.001);妊娠期LVCO的升高为HR和SV共同增高的结果,且与二者呈显著正相关(r=0.728,P<0.0001;r=0.866,P<0.0001);左心室壁及心肌质量(IVSd、LVPWd、LVM、LVMI)随孕周逐渐增厚或增加,晚孕组达最大,组间差异均有统计学意义(P<0.05或P<0.01);左心房室收缩功能(LAEF、LVEF、PER)未显示明显差异(P>0.05),仅于孕中期略高;左室舒张功能E/A比值随孕周逐渐减小(P<0.05),但仍大于l,LVPFR孕中晚期较对照组及早孕组略高(P>0.05),体现了舒张早期左室主动充盈能力代偿性轻度升高。结论:健康孕妇循环系统对妊娠带来的巨大变化是积极适应的。FV-3DE技术作为反映妊娠期心脏重构及血流动力学变化的一种全新手段,可以逐渐常规应用于临床早期评估妊娠期母体心脏功能。更多还原

【Abstract】 Objective: Prominent adaptable changes of structure, function and hemodynamics have taken place in normal pregnant women’s cardiovascular system. Because of its characteristics of convenience, noninvasion, accuratissime, cheap and strong repetitiveness, echocardiography became one of the important means of detecting maternal cardiac function by clinic from the later stage of the seventies. There were a large number of researches evaluating cardiac structure, systolic and diastole function using conventional ME, 2DE and doppler echocardiography. RT-3DE is a great technological break-through in the field of cardiac ultrasonic imaging for the past few years. Full volume imaging is one mode of RT-3DE.But the report of evaluating normal pregnant women’s cardiac function by full volume imaging is rare now. The study was designed to investigate the value of the early quantitation in healthy pregnant women’s left cardiac function using new technique FV-3DE.Methods: The left heart of 52 healthy pregnant women (15 first trimester, 18 second trimester and 19 third trimester ) and 20 age matching healthy nonpregnant women(control group) were detected by FV-3DE and conventional echocardiography. The left cardiac parameters of healthy pregnant women group and control group were compared and analyzed.They were:left atrial function (LAVmax, LAVmin, LAEF, LASV), left ventricular mass (LVM, LVMI), left ventricular function (LVEDV, LVESV, LVSV, LVEF, LVCO, LVCI, PER, PFR); left cardiac structure and function (LVEDd, IVSd, LVPWd, LAs; E, A and E/A ).Meanwhile, the hemodynamic indexes (MBP,TPR) were analyzed . Results: The imaging satisfactory rates of FV-3DE were 100%(the control group and the first trimester), 88.9%(16/18, the second trimester), 78.9% (15/19, the third trimester), respectively. There was a high-flow,low-resistance hemodynamic state during normal pregnancy. TPR decreased during all three trimesters of pregnancy(P<0.01),the lowest in the third trimester. MBP changed slightly throughout pregnancy(P>0.05). During gestational period the healthy pregnant women’s cardiovascular system remodeled because of the growth of circulation volume and the long-term overloading. With the gestational development, the healthy pregnant women’s left atrial and ventricular diameter and volume (LAs, LAVmax, LAVmin, LVEDd, LVEDV, LVESV), stroke volume (LASV, LVSV), LVCO and LVCI increased gradually, peaked in the last weeks of pregnancy(P<0.05,P<0.01,P<0.001). LVCO increased in early pregnancy,as a result of the increased HR and SV, they correlated linearly with r=0.728 ,(P<0.0001)and r=0.866,(P<0.0001),respectively. IVSd, LVPWd, LVM and LVMI peaked in the third trimester (P<0.05,P<0.01).They all showed left ventricular hypertrophy in the late duration of pregnancy. The left atrial and ventricular systolic function(LAEF, LVEF, PER)seemed to be slightly increased during midpregnancy(P>0.05).While the left ventricular diastole function decreased a little through gestation(P<0.05),but remained in the normal range, LVPFR seemed to be slightly increased during midpregnancy too(P>0.05), showing the compensasive increasing of left ventricular initiative filling ability.Conclusions: Maternal cardiovascular adaptive changes in pregnancy are active preparations. As a new means of reflecting cardiac remodeling and hemodynamic changes in pregnancy ,FV-3DE will be used in evaluating healthy pregnant women cardiac function by clinical routine gradually.更多还原