本文關鍵詞：PW-TDI及Mod-MPI在評估妊娠高血壓子癇前期胎兒左心功能中的應用　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 組織多普勒超聲心動圖 胎兒左心功能 超聲檢查 妊娠高血壓 改良式心肌活動指數(shù)

【摘要】：目的:探討應用脈沖組織多普勒及改良心肌活動指數(shù)聯(lián)合評價不同程度子癇前期胎兒的左心功能。方法:選擇2015年10月至2016年06月在赤峰學院附屬醫(yī)院超聲科進行檢查的孕中、晚期妊娠高血壓子癇前期孕婦32例作為實驗組,根據(jù)子癇前期孕婦的收縮壓、舒張壓、尿蛋白及癥狀等將實驗組分為兩組:輕度子癇前期組(MPE)13例、重度子癇前期組(SPE)19例;另選同期在我院超聲科進行檢查的正常中晚期妊娠孕婦50例作為對照組(CG),應用超聲脈沖組織多普勒測定胎兒左心功能指標:即二尖瓣后葉瓣環(huán)處心肌舒張早期運動峰值Ea、舒張晚期運動峰值Aa、收縮期運動峰值S,二尖瓣瓣口血流舒張早期峰值E、舒張晚期峰值A,以及Mod-MPI相關指標:左心室射血期時間(ET)、等容舒張期時間(IVRT)及等容收縮期時間(IVCT)。然后對E、A、Ea、Aa、S、E/A、Ea/Aa、E/Ea及改良心肌活動指數(shù)Mod-MPI即[(IVCT+IVRT)/ET]進行測定、計算,并對對照組、輕度子癇前期組、重度子癇前期組的相關參數(shù)通過單因素方差分析及t檢驗等方法進行相關結果的統(tǒng)計學分析。結果:1、各組一般資料的比較實驗組孕齡、臍動脈血流S/D值均高于對照組,差異無統(tǒng)計學意義(P0.05)。2、實驗組E、A以及Aa值均低于對照組,差異無統(tǒng)計學意義(P0.05);重度子癇前期組Ea、Ea/Aa低于對照組、E/Ea高于對照組,差異有統(tǒng)計學意義(P0.05);輕度子癇前期組E/Ea較對照組高,Ea、Ea/Aa較對照組低,差異無統(tǒng)計學意義(P0.05);重度子癇前期組Ea/Aa、Ea值低于輕度子癇前期組、E/Ea高于輕度子癇前期組,差異無統(tǒng)計學意義(P0.05)。3、實驗組S值、ET值低于對照組,差異無統(tǒng)計學意義(P0.05)。4、重度子癇前期組(IVCT+IVRT)及Mod-MPI高于對照組,差異有統(tǒng)計學意義(P0.05);輕度子癇前期組(IVCT+IVRT)及Mod-MPI較對照組高,差異無統(tǒng)計學意義(P0.05)。結論:1.多項實驗數(shù)據(jù)統(tǒng)計顯示,胎兒左心舒張功能、收縮功能及整體功能在不同程度妊娠期高血壓子癇前期時均已受到一定程度的損害,且其受損程度在對照組、MPE組、SPE組中呈現(xiàn)出逐漸上升的趨勢。這印證了孕婦的血壓高低可影響胎兒左心功能,血壓越高胎兒的左心功能受損越顯著。2.在反映胎兒左室的舒張功能時,多普勒組織成像(TDI)技術測得的二尖瓣瓣環(huán)處的心肌運動峰值速度較二尖瓣瓣口舒張期血流運動峰值速度更敏感、真實。在實際工作中由于各種超聲檢查方法都存在一定的局限性,加之胎兒心臟本身的特殊性,為了更加準確地評價胎兒左心功能就必須采取多種方法綜合評判。
[Abstract]:Objective: to evaluate the left ventricular function of fetuses with different degrees of preeclampsia by pulse tissue Doppler and modified myocardial activity index. Select pregnant women who were examined in the Department of Ultrasound from October 2015 to June 2016 in the affiliated Hospital of Chifeng College. Thirty-two pregnant women with pre-eclampsia were used as experimental group according to systolic blood pressure and diastolic blood pressure of pre-eclampsia pregnant women. Urine protein and symptoms were divided into two groups: mild preeclampsia group (n = 13) and severe preeclampsia group (n = 19). In addition, 50 normal pregnant women with intermediate and late pregnancy who were examined by ultrasound department in our hospital at the same time were selected as the control group (CGG). The indexes of fetal left ventricular function were measured by ultrasonic pulse tissue Doppler: early diastolic peak (EA), late diastolic movement peak (Aa) and systolic motion peak (S) at the posterior lobe annulus of mitral valve. Mitral orifice early diastolic peak E, late diastolic peak A, and Mod-MPI related indexes: left ventricular ejection time (et). Isovolumic diastolic time (IVRTT) and isovolumic contraction time (IVCTT). E / EA and modified myocardial activity index (Mod-MPI). [IVRT)/ET was measured, calculated, and compared with control group, mild preeclampsia group. The related parameters of severe preeclampsia group were statistically analyzed by single factor analysis of variance and t test. Results: 1. The gestational age of the experimental group was compared with the general data of each group. The S / D value of umbilical artery blood flow was higher than that of the control group, there was no significant difference between the two groups (P 0.05). The values of EMA and AA in the experimental group were lower than those in the control group (P 0.05). In severe preeclampsia group, EA / A was significantly lower than that in control group (P 0.05). The E- / EA of mild preeclampsia group was lower than that of the control group (P < 0.05). In severe preeclampsia group, EA / AaFEA value was lower than that in mild preeclampsia group, which was higher than that in mild preeclampsia group, there was no significant difference (P0.05. 3), the S value of experimental group was higher than that of mild preeclampsia group. The level of et was lower than that of the control group (P 0.05) and Mod-MPI was higher than that of the control group (P 0.05). The difference was statistically significant (P 0.05). Mod-MPI and IVCT in mild preeclampsia group were higher than those in control group (P 0.05). The left ventricular diastolic function, systolic function and global function were all damaged in different degree of hypertensive preeclampsia in pregnancy, and the degree of damage was in MPE group. In SPE group, there was an increasing trend, which confirmed that maternal blood pressure can affect fetal left heart function, the higher the fetal blood pressure, the more significant left heart function damage. 2. In reflecting the left ventricular diastolic function of fetus. The peak velocity of myocardial movement at mitral annulus measured by Doppler tissue imaging TDI technique was more sensitive than that at mitral valve orifice diastolic phase. In the actual work, due to the limitations of various ultrasound examination methods, coupled with the particularity of the fetal heart itself. In order to evaluate fetal left ventricular function more accurately, a variety of methods must be adopted.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.246;R445.1

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