Fetal Left Ventricular Modified Myocardial Performance Index Thiab Lub raum Artery Pulsatility Index nyob rau hauv cev xeeb tub nrog cais Oligohydramnios Ua ntej 37 lub lis piam ntawm cev xeeb tub
Mar 31, 2022
Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791
Taw qhia
Kev ntsuas qhov ntim ntawm cov kua amniotic yog ib feem ntawm obstetric sonography thiab qhov txawv txav ntawm cov kua dej amniotic muaj feem cuam tshuam rau kev pheej hmoo rau qhov tshwm sim tsis zoo (1). Cov kua dej amniotic (AFI) Tsawg dua lossis sib npaug li 5 cm lossis ib lub hnab ntim ntsug ntawm cov kua dej amniotic Tsawg dua lossis sib npaug li 2 cm yog cov ntsiab lus ntau tshaj plaws rau oligohydramnios. Kwv yees li ntawm 0.5 feem pua rau 5 feem pua ntawm cev xeeb tub yog qhov nyuaj los ntawm oligohydramnios (2). Oligohydramnios tsis muaj fetal structural thiab chromosomal abnormalities, intrauterine kab mob, uteroplacental insufficiency, ntxov ntxov rupture ntawm daim nyias nyias, thiab paub leej niam kab mob yog hu ua cais oligohydramnios (3). Raws li cov ntaub ntawv, obstetrical tshwm sim ntawm cev xeeb tub nrog cais oligohydramnios yog teeb meem. Qee qhov kev tshawb fawb tau pom tias kev sib cais oligohydramnios yog qhov kev kwv yees ntawm qhov tshwm sim tsis zoo (4,5) thaum lwm tus tsis tau lees paub lub koom haum (3,6).
Kev ua haujlwm ntawm lub plawv fetal tuaj yeem ntsuas qhov tsis muaj kev cuam tshuam los ntawm kev ntsuas Doppler-derived myocardial Performance index (MPI) (7). Tsawg qhov sib txawv thiab siab dua qhov kev pom zoo ntawm cov neeg soj ntsuam hauv nruab nrab tau txais nrog kev hloov kho ntawm myocardial Performance index (Mod-MPI) (8). Siab dua Mod-MPI qhov tseem ceeb tau pom tias muaj feem cuam tshuam nrog sab laug ventricular tsis ua haujlwm (9). Sab laug Mod-MPI tau raug tshawb xyuas nyob rau hauv ntau qhov kev xeeb tub nyuaj los ntsuam xyuas tus menyuam hauv plab tsis ua haujlwm (10-12). Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, tsis muaj kev tshawb fawb tsom mus rau fetal cardiac function nyob rau hauv cais oligohydramnios.
Lub ntsiab tseem ceeb ntawm cov kua amniotic yog fetal tso zis nyob rau hauv lub thib ob thiab thib peb trimesters. Yog li, qhov txo qis ntawm cov kua dej amniotic tuaj yeem pom qhov thib ob rau cov me nyuam hauv plablub raum ua haujlwm (13) . Lub raum arterial perfusion cuam tshuam cov zis tso zis ncaj qha, uas tuaj yeem ntsuas nrog rau lub raum hlab ntsha Doppler tsis. Txawm li cas los xij, cov txiaj ntsig ntawm kev tshawb fawb tsom mus rau kev hloov pauv hauv lub raum Doppler tsis nyob rau hauv kev sib cais oligohydramnios tsis tau pom zoo thiab yog li nws nyuaj rau hais tias cais oligohydramnios cuam tshuam nrog rau lub raum hlab ntsha Doppler tsis muaj (14-16).
Lub hom phiaj ntawm txoj kev tshawb no yog los tshawb xyuas seb cev xeeb tub ua ntej 37 lub lis piam ntawm cev xeeb tub nrog kev sib cais oligohydramnios sib txawv hauv kev ntsuas ntawm fetal cardiac functions thiab lub raum cov hlab ntsha ntws nrawm nrawm los ntawm cov uas cev xeeb tub nrog cov kua dej amniotic. Qhov tshwm sim ntawm cev xeeb tub ntawm ob pawg no kuj tau muab piv thiab tus nqi ntawm sab laug Mod-MPI nyob rau hauv kev kwv yees ntawm qhov tshwm sim tsis zoo perinatal raug soj ntsuam.
Ntsiab lus:Isolated oligohydramnios, myocardial Performance index, perinatal tshwm sim, preterm, lub raum hlab ntsha Doppler
Khoom siv thiab cov txheej txheem
Txoj kev tshawb fawb yav tom ntej no tau ua thaum Lub Yim Hli 2017 thiab Lub Rau Hli 2018 hauv Istanbul University chav tsev ntawm Cerrahpaşa, hauv Cerrahpaşa Kws Qhia Tshuaj, Department of Obstetrics thiab Gynecology, Division of Perinatology. Tom qab kev pom zoo rau kev coj ncaj ncees (Istanbul University-Cerrahpaşa, Cerrahpaşa Kws Qhia Ntawv ntawm Tshuaj Kho Mob Ethical Committee (tus naj npawb pom zoo: 215728), nees nkaum tsib cev xeeb tub nrog cais oligohydramnios ntawm 24 ntxiv rau 0 txog 36 ntxiv rau 6 lub lis piam gestation raug xaiv dua los yog AFI sib npaug. 5 cm tau txhais tias yog oligohydramnios.Cov ntsiab lus no tau sib tw nrog 25 noj qab haus huv, gestational age-matched singleton cev xeeb tub nrog cov kua amniotic ib txwm (AFI: 8-25} cm). Lwm yam kab mob ntev; rupture ntxov ntxov ntawm daim nyias nyias; txwv kev loj hlob ntawm fetal; fetal kab mob; structural los yog chromosomal txawv txav; thiab cev xeeb tub nrog pathological umbilical thiab uterine hlab ntsha Doppler indices. Thaum lub sij hawm kawm, Voluson E10 C4-8-D (GE Healthcare, Zipf, Austria) nkhaus thiab convex array probes tau siv.
Tom qab tau txais kev tso cai pom zoo, kev kuaj mob ntawm tus menyuam hauv plab tau ua tiav thiab AFI tau suav nrog siv {{0}} txoj kev plaub fab (1). Nyob rau hauv lub apical plaub-chamber saib, Doppler qauv rooj vag tau khaws cia ntawm 3 hli thiab nyob rau ntawm sab laug phab ntsa ntawm ascending aorta, nruab nrab ntawm cov nplooj ntawv ntawm lub aortic li qub (AV) thiab mitral li qub (MV). Lub kaum sab xis ntawm insonation yog nyob nruab nrab ntawm 0 thiab 300, thiab qhov ceev tshaj plaws Doppler sweep (15 cm / s) tau siv. Isovolumetric contraction time (ICT) tau ntsuas los ntawm MV kaw rau AV qhib. Lub sijhawm tshem tawm (ET) raug ntsuas los ntawm AV qhib mus rau kaw. Isovolumetric so lub sij hawm (IRT) tau ntsuas los ntawm AV kaw mus rau MV qhib (Daim duab 1). Mod-MPI tau suav nrog cov qauv (ICT ntxiv rau IRT) / ET. Peb qhov kev ntsuas sib law liag tau ua thiab tus nqi nruab nrab yog siv rau kev suav. Txhawm rau ntsuaslub raumCov hlab ntsha ntshav khiav, lub dav hlau coronal tau txais thiab lub rooj vag Doppler nyob rau ntawm qhov chaw thib peb ntawmlub raumcov hlab ntsha (Daim duab 2). Lub kaum sab xis ntawm insonation yog ze rau 0 degree . Peb qhov kev ntsuas sib law liag tau ua rau kev suav ntawm qhov nruab nrab sab laug thiab sab xislub raumartery pulsatility index (PI).
Kev xeeb tub nrog oligohydramnios cais tau ua raws txhua 2-3 lub lis piam nrog cov hlab ntsha hauv plab Doppler mus txog 32 lub lis piam ntawm cev xeeb tub thiab txhua 1-2 lub lis piam nrog kev kuaj tsis muaj kev ntxhov siab (NST) thiab cov hlab ntsha hauv plab Doppler txog 36 lub lis piam gestation thiab ob zaug ib lub lim tiam. tom qab ntawd. Persisently non-reactive NST tau siv los ua qhov qhia txog kev xa khoom. Kev ua haujlwm raug ntxias nyob rau hauv kev sib cais oligohydramnios kis ntawm 39 lub lis piam gestation yog tsis xa ua ntej. Kev xeeb tub nrog cov kua dej amniotic ib txwm tau ua raws txhua plaub lub lis piam mus txog 36 lub lis piam ntawm cev xeeb tub thiab tshuaj xyuas ntawm 38 lub lis piam thiab 39 lub lis piam ntawm cev xeeb tub thiab ob zaug ib lim tiam tom qab ntawd mus txog 41 lub lis piam ntawm cev xeeb tub. Kev ua haujlwm raug ntxias ntawm 41 lub lis piam gestation yog tsis xa ua ntej. Cov txheej txheem ua raws li cov neeg mob tau pom nyob rau hauv daim duab 3. Txoj kev ntawm kev yug me nyuam, lub hnub nyoog gestational thaum yug los, qhov hnyav thaum yug, thiab muaj meconium-stained amniotic kua thaum yug tau raug soj ntsuam. Cov txiaj ntsig tseem ceeb yog piv rau sab laug Mod-MPI thiab txhais tau tias fetallub raumartery PI thiab cov txiaj ntsig thib ob yog los sib piv cov txiaj ntsig perinatal tsis zoo ntawm cov pab pawg. Cov txiaj ntsig tsis zoo perinatal tau txhais tias yog txoj hlab ntaws hlab ntsha pH<7.2, apgar="" 5="" min=""><7, cesarean="" delivery="" for="" non-reassuring="" fetal="" heart-rate="" testing,="" transient="" tachypnea="" of="" the="" newborn="" (ttn),="" respiratory="" distress="" syndrome="" (rds),="" admission="" to="" the="" neonatal="" intensive="" care="" unit="" (nicu),="" hypoxic-ischemic="" encephalopathy="" (hie),="" and="" neonatal="">
Kev txheeb caistau tsim nrog SPSS version 20.0 (IBM Inc., Armonk, NY, USA). Categorical cov ntaub ntawv tau txheeb xyuas siv qhov kev xeem chi-square los yog Fisher qhov tseeb. Cov lej sib txawv tau muab piv nrog Cov Tub Ntxhais Kawm T-test lossis Mann-Whitney U xeem. Pearson qhov kev sib raug zoo hauv qib tau siv los ntsuas qhov kev sib raug zoo ntawm MPI thiab cov txiaj ntsig tsis zoo ntawm lub cev. Ib p-value<0.05 and="" r="">0.5 raug suav hais tias yog qhov tseem ceeb.
Cov txiaj ntsig
Cov yam ntxwv kho mob ntawm cev xeeb tub nrog oligohydramnios cais thiab cov kua amniotic ib txwm muaj nyob rau hauv Table 1. Cov hnub nyoog niam txiv thiab cov nulliparity tsis txawv. Lub hnub nyoog gestational ntawm ultrasound thiab umbilical artery PI qhov tseem ceeb tau zoo sib xws ntawm ob pawg. Unsurprisingly, txhais tau tias AFI yog qhov sib txawv ntawm 31 mm thiab 109 mm nyob rau hauv cov cais oligohydramnios thiab tswj pawg, ntsig txog (p<0.001). cardiac="">lub raumCov hlab ntsha Doppler cov kev txwv ntawm cev xeeb tub nrog cais oligohydramnios thiab pawg tswj tau nthuav tawm hauv Table 2. Qhov nruab nrab Mod-MPI tus nqi tau nce siab dua thiab IRT tau ntev dua nyob rau hauv pawg oligohydramnios cais ntau dua li hauv pawg tswj hwm (p=0.001 thiab p=0.009, raws). Txhais tau tias ICT, ET qhov tseem ceeb thiab txhais tau tiaslub raumartery PI qhov tseem ceeb tsis txawv ntawm cov oligohydramnios cais thiab tswj pawg. Perinatal tshwm sim nyob rau hauv cov cais oligohydramnios thiab pab pawg tswj tau qhia nyob rau hauv Table 3. Gestational lub hnub nyoog ntawm yug thiab yug me nyuam qhov hnyav tau qis dua (p=0.041 thiab p=0.001, raws li), thiab tshwm sim ntawm kev yug me nyuam ua ntej 37 lub lis piam thiab kev phais mob phais vim tsis muaj kev ntsuam xyuas lub plawv dhia hauv plab tau tshwm sim ntau dua (p=0.034 thiab p=0.021, raws li) hauv cov poj niam uas muaj oligohydramnios cais ntau dua li pawg tswj hwm. . Qhov tshwm sim ntawm kev ua haujlwm induction, arterial cord ntshav pH<7.2, apgar="" 5="" min=""><7, meconium-stained="" amniotic="" fluid,="" admission="" to="" nicu,="" ttn,="" hie,="" rds,="" and="" neonatal="" death="" were="" not="" significantly="" different="" between="" the="" groups.="" preterm="" induction="" of="" labor="" was="" performed="" in="" two="" patients="" with="" isolated="" oligohydramnios="" due="" to="" non-reassuring="" fetal="" heart="" rate="" at="" 36-37="" weeks="" gestation.="" there="" was="" no="" significant="" correlation="" between="" mod-mpi="" value="" and="" adverse="" perinatal="" outcomes="" (pearson's="" p="0.112," p="">
costanche
Kev sib tham
Nyob rau hauv txoj kev tshawb no tam sim no, nws tau pom tias cev xeeb tub nrog oligohydramnios cais ua ntej 37 lub lis piam yog tus cwj pwm los ntawm tus nqi siab dua ntawm kev yug menyuam ntxov thiab tus nqi siab dua ntawm kev yug me nyuam rau qhov tsis muaj kev ntsuam xyuas lub plawv dhia hauv plab thaum lub sij hawm ua hauj lwm. Txawm li cas los xij, qhov tshwm sim tsis zoo ntawm perinatal xws li hlab ntsha pH<7.2, apgar="" 5="" min=""><7, meconium-stained="" amniotic="" fluid,="" admission="" to="" nicu,="" and="" neonatal="" death="" were="" not="" significantly="" different="" between="" the="" pregnancies="" with="" isolated="" oligohydramnios="" and="" normal="" amniotic="" fluid="" volumes.="" although="" we="" observed="" a="" higher="" rate="" of="" preterm="" delivery="" in="" the="" isolated="" oligohydramnios,="" the="" neonatal="" morbidity="" was="" similar.="" one="" possible="" explanation="" for="" this="" discrepancy="" might="" be="" the="" higher="" rate="" of="" late="" preterm="" deliveries="" at="" a="" gestational="" age="" of="" 36-37="" weeks.="" although="" it="" has="" been="" reported="" that="" isolated="" oligohydramnios="" at="" preterm="" pregnancy="" is="" associated="" with="" a="" higher="" rate="" of="" adverse="" neonatal="" outcomes,="" subgroup="" analysis="" showed="" that="" adverse="" outcomes="" were="" substantially="" related="" to="" the="" induction="" of="" delivery="" but="" not="" to="" the="" isolated="" oligohydramnios="" itself="" (6).="" melamed="" et="" al.="" (6)="" showed="" that="" the="" neonatal="" outcome="" in="" the="" isolated="" oligohydramnios="" group="" (expectant-management)="" was="" similar="" to="" that="" observed="" in="" the="" control="">
Kev soj ntsuam meta tsis ntev los no suav nrog rau 6 txoj kev tshawb fawb ntawm oligohydramnios cais hauv 27,526 tus poj niam tau pom tias cev xeeb tub nrog kev sib cais oligohydramnios tau muaj tus nqi siab dua ntawm meconium aspiration syndrome, kev phais mob rau tus menyuam hauv plab thiab nkag mus rau NICU. Nws tau xaus lus tias cais oligohydramnios yog ib qho kev tshawb nrhiav pathological thiab tsis muaj cov ntaub ntawv txaus los txiav txim siab lub sijhawm zoo ntawm kev xa khoom los txo qhov kev pheej hmoo ntawm qhov tshwm sim tsis zoo (5). Ntau qhov kev tshawb fawb tau tshaj tawm tias qhov tshwm sim hauv cev xeeb tub nrog kev sib cais oligohydramnios zoo ib yam li cev xeeb tub nrog cov kua dej amniotic (17,18). Peb qhov kev tshawb pom txhawb nqa cov kev tshawb fawb qhia tias cais oligohydramnios tsis cuam tshuam nrog qhov tshwm sim tsis zoo (6,17,18). Tus nqi ntawm cov kua amniotic nyob ntawmlub raumfiltration thiab tso zis ntau lawm.Lub raumCov hlab ntsha Doppler velocimetric tsis qhia txog cov hlab ntsha perfusion ntawm ob lub raum thiab cov kev txwv no yuav cuam tshuam txog qib kua amniotic. Ntau qhov kev tshawb fawb tshawb fawb txog kev sib raug zoo ntawm fetallub raumCov hlab ntsha Doppler tsis muaj thiab cov kua dej amniotic tab sis cov txiaj ntsig ntawm cov kev tshawb fawb no tsis sib haum (14,15,19,20). Yoshimura et al. (20) qhia tiaslub raumCov hlab ntsha PI yog qhov muaj txiaj ntsig ntau dua hauv cov poj niam cev xeeb tub nrog cov oligohydramnios cais tawm piv rau cov poj niam cev xeeb tub nrog cov kua dej amniotic. Hauv lwm txoj kev tshawb fawb, suav nrog 63 cev xeeb tub ua raws li ntawm 16 txog 41 lub lis piam, tsis muaj kev cuam tshuam ntawm cov kua dej amniotic thiab fetal.lub raumartery PI (14). Benzer et al. (15) soj ntsuamlub raumcov hlab ntshaPI thaum cev xeeb tub nrog oligohydramnios ntawm 22, 28, thiab 34 lub lis piam ntawm cev xeeb tub thiab pom muaj ntau dualub raumcov hlab ntshaPI tsuas yog thaum muaj hnub nyoog 28 lub lis piam, tab sis tsis nyob ntawm 22 lossis 34 lub lis piam. Budunoglu et al. (16) qhia tiaslub raumCov hlab ntsha PI tsis txawv txav ntawm cov neeg mob uas muaj kev sib cais oligohydramnios thiab cov kua dej amniotic ntawm 25 txog 40 lub lis piam ntawm cev xeeb tub. Hauv kev kawm tam sim no,lub raumCov hlab ntsha PI tsis txawv txav ntawm cov poj niam cev xeeb tub ua ntej 37 lub lis piam ntawm cev xeeb tub nrog oligohydramnios cais thiab cov kua dej amniotic ib txwm, qhia tias kev sib cais oligohydramnios yuav tsis cuam tshuam rau kev puas tsuaj.lub raumntshav hlab ntsha.
sib
Mod-MPI qhov tseem ceeb yog txuam nrog fetal sab laug ventricular muaj nuj nqi thiab nws tau dhau los ua tus cim txhim khu kev qha ntawm fetal cardiac dysfunction. Fetal MPI tau raug soj ntsuam nyob rau hauv ntau qhov kev pheej hmoo xeeb tub, xws li mob ntshav qab zib thiab tom qab cev xeeb tub, kev txwv tsis pub loj hlob ntawm tus menyuam, thiab ntxaib-hloov mob (12,21,22). Peb tau soj ntsuam Mod MPI thaum cev xeeb tub nrog kev sib cais oligohydramnios thiab ua kom pom kev ua haujlwm tsis zoo ntawm lub plawv hauv fetuses nrog cais oligohydramnios piv nrog kev tswj hwm kev noj qab haus huv. Cov qib Mod-MPI siab dua tau pom tias feem ntau yog vim qhov siab IRT. IRT ua qhov txawv txav hauv thawj theem ntawm kev mob plawv thiab feem ntau yog tshwm sim los ntawm kev txo qis diastolic ua raws (23). Calcium reuptake ntawm myocardial hlwb raug txo, uas ua rau kom ntev ntawm kev ua tiav cardiomyocyte so thiab nce IRT (24). Raws li qhov kev tshawb pom ntawm qhov kev tshawb fawb tam sim no, peb kwv yees tias tej zaum yuav muaj qhov ua tsis taus pa me me hauv cov menyuam hauv plab nrog oligohydramnios cais. Txawm li cas los xij, txawm hais tias oligohydramnios yog qhov ua rau ib tus se lossis qhov tshwm sim ntawm kev ua haujlwm me me diastolic tsis meej. Muaj tsuas yog ib txoj kev tshawb fawb uas tau soj ntsuam kev sib koom ua ke ntawm qhov ntim ntawm amniotic kua thiab Mod-MPI thaum cev xeeb tub nrog polyhydramnios cais. Hauv txoj kev tshawb no, Mod-MPI tau nce siab dua hauv cov polyhydramnios cais tawm piv nrog kev tswj hwm, thiab Mod-MPI kuj tseem cuam tshuam nrog cov txiaj ntsig tsis zoo rau lub cev (25). Txawm li cas los xij, txawm hais tias Mod-MPI tau nce ntau ntxiv hauv kev sib cais oligohydramnios cev xeeb tub hauv peb txoj kev tshawb fawb, peb tsis tuaj yeem ua kom pom kev sib koom ua ke ntawm Mod-MPI qhov tseem ceeb thiab qhov tshwm sim tsis zoo hauv cov menyuam hauv plab nrog oligohydramnios cais. Peb txoj kev tshawb fawb qhia tias Mod-MPI kev ntsuam xyuas tsis zoo li yuav pab tswj kev xeeb tub ua ntej 37 lub lis piam gestation nrog oligohydramnios cais. Lub zog ntawm txoj kev tshawb no yog nws txoj kev tsim thiab kev ntsuas ntawm Doppler tsis tau los ntawm ib tus kws tshuaj xyuas ib leeg. Txawm li cas los xij, qhov kev txwv ntawm txoj kev tshawb no yog cov qauv me me.
Xaus
Fetuses nrog cais oligohydramnios tau nce Mod-MPI uas tej zaum yuav yog vim mob me me ntawm lub plawv diastolic tsis ua haujlwm. Kev nce Mod-MPI tsis cuam tshuam nrog qhov tshwm sim tsis zoo ntawm perinatal hauv fetuses nrog cais oligohydramnios. Cov kev tshawb fawb loj ntxiv yog xav tau los tshawb xyuas qhov tseem ceeb ntawm Mod-MPI hauv kev sib cais oligohydramnios.
ceg tcm
