摘要目的：通过超声评价单绒毛膜双羊膜囊（MCDA）双胎选择性宫内生长受限（sIUGR）胎儿心功能，为临床抉择及手术时机选择提供参考。方法选择2013年12月至2014年9月在中山大学附属第一医院医学中心确诊 sIUGR 之初的孕妇24例，平均年龄28岁，中位孕周22周（18~26周）；选择同期同医院正常MCDA 双胎孕妇20例，平均年龄31岁，中位孕周27周（19~34周）。超声测量脐动脉（UA）、脐静脉（UV）、静脉导管血流频谱及静脉导管搏动指数（DV-PI）、房室瓣及半月瓣血流频谱、三尖瓣环收缩期位移（TAPSE）、左心室短轴缩短率（FS）、左右心室 Tei 指数，比较 sIUGR 大小胎间心功能及正常 MCDA 双胎间心功能。结果正常 MCDA 双胎在心率、DV-PI、心胸面积比、FS、TAPSE、左心室 Tei 指数（分别为0.34±0.03、0.34±0.04）、右心室 Tei 指数（分别为0.35±0.03、0.35±0.03）比较，差异均无统计学意义（P 均﹥0.05）。sIUGR 大胎心胸面积比、室壁厚度、等容舒张时间（IRT）、等容收缩时间（ICT）、TAPSE、三尖瓣反流均高于小胎，差异均有统计学意义（P 均﹤0.05），左右心室 Tei 指数高于小胎（大小胎左心室 Tei 指数分别为0.43±0.06、0.35±0.04，右心室 Tei 指数分别为0.43±0.06、0.34±0.04，P ﹤0.05），二、三尖瓣舒张早晚期血流峰值比值（E/ A）及二、三尖瓣舒张期血流充盈时间占心动周期百分比（ inflow/ CCL）低于小胎，差异均有统计学意义（P 均﹤0.05）。结论正常 MCDA 双胎间心脏收缩舒张功能差异无统计学意义，sIUGR 初诊时大胎心脏已有舒张功能异常，监测胎儿心功能状况可为临床干预提供参考。

abstractsObjective To evaluate the fetal cardiovascular function in selective intrauterine growth restriction (sIUGR)in monochorionic diamniotic(MCDA)twins by using 2D and color Doppler ultrasonography. Methods Twenty - four sIUGR pregnancies and 20 normal MCDA twins pregnancies were enrolled at the First Affiliated Hospital of Sun Yat - Sen University from December 2013 to September 2014,and cardiac structure of fetus and Doppler patterns of the umbilical artery(UA),umbilical vein(UV),pulsatility index of ductus venosus(DV - PI),atrioventricular valve, semilunar valve,tricuspid annulus systolic displacement(TAPSE),fractional shortening of left ventricle short axis(FS) and myocardial performance index(Tei index)of both ventricles were assessed. Results Cardiothoracic ratio,heart rate,DV - PI,FS,TAPSE,Tei index of the left ventricle(0. 34 ± 0. 03,0. 34 ± 0. 04),Tei index of the right ventricle (0. 35 ± 0. 03,0. 35 ± 0. 03)were not significantly different compared with those of the normal MCDA twins(all P ﹥0. 05). Cardiothoracic ratio,ventricular wall thickness,isovolumetric relaxation time( IRT),isovolumetric contraction time(ICT),TAPSE and tricuspid regurgitation(TR)in the larger twins of sIUGR were significantly bigger than those in the smaller twins of sIUGR(all P ﹤ 0. 05),Tei index of both ventricles in the larger twin of sIUGR was significantly higher than that in the smaller twins of sIUGR(Tei index of left ventricle:0. 43 ± 0. 06 vs 0. 35 ± 0. 04,Tei index of right ventricle:0. 43 ± 0. 06 vs 0. 34 ± 0. 04,P ﹤ 0. 05),the peak E in early diastolic / the peak A in atrial contraction (E/ A),the percentage of inflow during of cardiac cycle length(inflow/ CCL)in larger twin of sIUGR were significantly lower than those in smaller twin of sIUGR(all P ﹤ 0. 05). Conclusions There was no difference of cardiac function in normal MCDA twins,at the beginning of the diagnosis of sIUGR,cardiac dysfunction were found in larger twin,follow -up examination are helpful to clinical decision.