摘要
目的研究孕妇短时间内高浓度吸氧对肺动脉狭窄胎儿的肺动脉及大脑中动脉(middle cerebral artery,MCA)血流的影响。方法对2016年10月至2017年3月间在广东省心血管病研究所确诊的14例单纯肺动脉狭窄或肺动脉狭窄合并其他右心畸形的单胎先天性心脏病(先心病)胎儿进行吸氧试验,胎儿超声心动图观察孕妇吸氧前、面罩高浓度吸氧10 min后胎儿MCA起始部搏动指数(pulsatility index,PI)、阻力指数(resis-tance index,RI)、收缩期峰值流速(peak systolic velocity,PSV)变化,脐动脉(umbilical artery,UA)-RI的变化,以及右肺动脉(right pulmonary arterial,RPA)起始部PI、RPA起始部内径(diameter,D)及PSV的变化。结果吸氧前后胎儿RPA-D比较,差异有统计学意义[(2.64±0.60)mm vs.(3.27±0.69)mm,P=0.001];吸氧前后胎儿MCA-PI(1.79±0.43 vs. 1.92±0.44,P=0.517)、MCA-RI[0.83(0.78～0.86)vs. 0.85(0.78～0.90),P=0.517]、MCA-PSV[0.32(0.27～0.47)m/s vs. 0.31(0.26～0.32)m/s,P=0.812]、PRA-PI(2.21±0.53 vs. 2.10±0.48,P=0.253)、RPA-PSV[0.81(0.65～0.91)m/s vs. 0.75(0.52～0.95)m/s,P=0.875]、UA-PI(1.17±0.15 vs. 1.2±0.12,P=0.567)比较,差异无统计学意义。结论孕妇在妊娠中晚期短暂吸氧对胎儿大脑血流无影响,但可促进胎儿肺动脉狭窄远端的肺血管扩张,可能有利于肺血管的发育,减少胎儿肺动脉瓣狭窄的继发性血管病变。
Objectives To research the effects of short time maternal hyperoxygenation （MHO） in pregnant women on blood flow of puhnonary arteries （PA） and middle cerebral arteries （MCA） in fetus with puhnonary stenosis （PS）. Methods Fourteen pregnant women with singleton gestation whose fetus had been diagnosed with PS or PS with other cardiac defects in Guangdong Cardiovascular Institute participated in this study. Doppler blood flow velocity waveforms were obtained from MCA, proximal right puhnonary arteiT （RPA） and umbilical artery （UA）. Pulsatility index （PI）, peak systolic velocity（PSV）, inner diameter（D） were calculated for RPA. PI, PSV and resistance index（RI） were calculated for MCA, and PI u-ere calculated for UA. Following baseline measurements, each woman received 60% humidified oxygen through an oxygen mask for 10 minutes. Doppler measurements u-ere then repeated. Results Maternal hyperoxygenation caused a significant increase in RPA-D values [ （2.64±0.60）mm vs. （3.27±0.69）mm, P=0.001 ]. MCAPI（1.79±0.43 vs. 1.92±0.44, P=0.517）, MCA-RI [0.83 （0.78-0.86） vs. 0.85 （0.78-0.90）, P=0.517], MCA-PSV [0.32 （0.27-0.47） m/s vs. 0.31 （0.26-0.32）m/s, P=0.812], PRA-PI （2.21±0.53 vs. 2.10±0.48, P=0.253）, RPA-PSV [0.81 （0.65-0.91）m/s vs. 0.75 （0.52-0.95）m/s, P=0.875 ], UA-PI （ 1.17±0.15 vs. 1.2±0.12, P=0.567）did not change significantly following MHO. Conclusions This study shows that there is no effect on cerebral blood flow or on umbilical blood flow following MHO in the second- and third-trimester fetus with PS, but MHO can promote fetal pulmonary vascular expansion, which may be beneficial to the growth of puhnonary vascular for PS fetus, and reduce the secondary vascular lesions of fetal puhnonary stenosis.
作者
王惠
潘微
周成斌
韩凤珍
陈寄梅
庄建
WANG Hui;PAN Wei;ZHOU Cheng-bin;HAN Feng-zhen;CHEN Ji-mei;ZHUANG Jian(Guangdong Cardiovascular Institute,Obstetrics Department of Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China;Maternal-fetal Heart Medics Department of Guangdong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China;Cardiac Surgery Department of Guangdong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)
出处
《岭南心血管病杂志》
2018年第5期571-575,共5页
South China Journal of Cardiovascular Diseases
基金
国家自然科学基金面上项目(项目编号:81370247)
广东省科技计划项目(项目编号:2014A020213010
2015A020210062
2017A070701013
2017B030314109)
关键词
肺动脉狭窄
吸氧
胎儿
pulmonary stenosis
hyperoxygenation
fetus
