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| 超声心动图评估双胎妊娠并发症孕妇左心结构、功能的研究 |
| 李晓菲,王莉,马玉庆,孙丽娟,张丽娜,安园园,邓笛,王晶晶,吴青青 |
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| (首都医科大学附属北京妇产医院) |
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| 摘要: |
| 目的 探讨双胎妊娠并发症孕妇左心结构、功能随孕周的变化规律。 方法 选取我院定期产前检查诊断的双胎妊娠并发症孕妇20例（病例组）和正常双胎妊娠孕妇50例（对照组），均已于妊娠早中期（11~14周）、妊娠中期（21~26周）及妊娠晚期（28~34周）行常规产前超声检查和成人超声心动图检查，对双胎妊娠并发子痫前期、胎儿生长受限孕妇的左心结构和功能进行纵向研究，并与正常双胎孕妇各相关参数进行比较。结果 两组孕妇左房舒张末期内径均随孕周增加而增长，其中病例组左房收缩末期内径在妊娠中晚期间显著增加，两组比较病例组妊娠早中期左室收缩末期内径高，差异有统计学意义（P＜0.05）；两组二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期运动峰值速度比值（E/e''）均随孕周增长而升高，但病例组心输出量（CO）、心脏指数（CI）、心率（HR）及左室射血分数（LVEF）随孕周增加无明显变化；与对照组比较，病例组妊娠早中期LVEF低，妊娠中期Tei指数高，两组比较差异有统计学意义（P＜0.05）。结论 双胎妊娠并发症孕妇左房舒张、收缩末期内径随孕周增大而增加，CO、CI及HR随孕周增加未出现正常适应性改变，妊娠早中期即可表现为左室收缩末期内径高、LVEF低，妊娠中期心脏整体功能较差。 |
| 关键词: 超声心动描记术 双胎妊娠并发症 心脏结构，左 心功能，左 |
| DOI： |
| 投稿时间：2018-01-21修订日期：2018-12-20 |
| 基金项目:国家重点研发计划（项目编号：2016YFC1000104）；北京市医院管理局“登峰”计划专项经费资助（编号：DFL20151302）；首都医科大学附属北京妇产医院院内课题（201207） |
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| Research of maternal left cardiac morphology，function in complicated twin pregnancy by echocardiography |
| Li Xiaofei,Wang Li,Ma Yuqing,Sun Lijuan,Zhang Lina,An Yuanyuan,Deng Di,Wang Jingjing,Wu qingqing |
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| Abstract: |
| Objective To investigate longitudinally maternal left cardiac morphologic and functional parameters change of complicated twin pregnancies. Methods A group of 20 complicated twin pregnancies who was diagnosed by regular prenatal examinations was obtained as study group for analysis and 50 normal twin pregnancies were selected as control group. These cases underwent serial fetal ultrasound examinations and maternal echocardiography at 11~14 weeks，21~26 weeks and 28~34 weeks of gestation examined and delivered in Beijing Obstetrics and Gynecology Hospital. Left cardiac morphologic and functional parameters were assessed longitudinally in complicated twin pregnancies who developed pre-eclampsia and fetal growth restriction，and compared with normal twin pregnancies.Results Maternal left atrial end-diastolic dimensions showed significant increase throughout the pregnancy period in both two groups，left atrial end-systolic dimensions showed significant increase in study group，especially between second- and thrid- trimester. Compared with control group，left ventricular end-systolic dimensions was higher and at 11~14 weeks， the difference was statistically significant(P＜0.05)；Peak velocity of Early diastolic period/peak velocity of early diastolic filling (E/e'') showed significant increase throughout the pregnancy period in both two groups，but cardiac output（CO），cardiac index（CI），heart rate（HR）and left ventricular ejection fractions（LVEF）remained stable throughout the pregnancy period in study group; Compared with control group，LVEF was lower at 11~14 weeks，and Tei index was higher at 21~26 weeks in study group, the difference was statistically significant between two groups(P＜0.05).Conclusion Left atrial end-systolic and end-diastolic dimensions showed significant increase in complicated twin pregnancies，but CO，CI，HR and LVEF does not undergo the profound adaptable longitudinal changes that occur in normal twin pregnancies，left ventricular end-systolic dimensions was higher and LVEF was lower at early second-trimester，and overall cardiac function was poor at second-trimester. |
| Key words: echocardiography complicated twin pregnancy maternal cardiac morphology,left maternal cardiac function,left |
