摘要目的 应用多普勒超声测量颈项透明层(NT)增厚胎儿的心内心外血流,观察血流动力学特点,分析其血流动力学改变与预后的关系.方法 2008年12月至2010年6月在首都医科大学附属复兴医院进行产前检查的孕妇2305名,其中1253名行妊娠早期超声检查.对其中单胎妊娠孕妇151名胎儿进行妊娠早期心内和心外血流的观察,常规观察妊娠11+0～14+6周胎儿大体形态,测量NT厚度和颈部软组织厚度.应用多普勒超声测量胎儿心内及心外血流,分析血流动力学特点,并与143名正常妊娠11+0～ 14+6周胎儿的心内及心外血流动力学参数进行比较.所有胎儿均在妊娠中期和新生儿期进行超声心动图检查,观察是否存在先天性心脏畸形和其他心外畸形.结果 NT增厚或软组织增厚者8例,其中1例在妊娠13周明确诊断为永存动脉干,后经引产后尸检证实；1例妊娠中期发现先天性肺囊腺瘤病变,引产后证实；1例妊娠中期发现胸腹水,选择终止妊娠；1例妊娠14周前选择终止妊娠；4例正常足月分娩,其中1例生后诊断肛门狭窄,其余新生儿正常.NT增厚不伴有心脏畸形胎儿,心内血流各项参数均在正常范围内,仪5例表现为静脉导管血流静脉导管搏动指数、阻力指数、收缩期高峰血流速度/舒张期最低血流速度值增高,其中包括中期检查异常胎儿和生后检查异常患儿.NT增厚伴有心脏结构异常胎儿的心内和心外血流均与正常之间有明显差异.结论NT增厚与染色体异常、先天性心脏畸形、其他结构异常以及不良预后密切相关.应用多普勒超声观察胎儿心内和心外血流可以有效判断胎儿心脏功能.当NT增厚胎儿的心内心外血流显示异常时,应高度怀疑伴有心脏结构异常；当出现心外血流波形异常或阻力增高,心内血流大致正常时,应结合临床染色体检查结果,密切注意预后.

abstractsObjective To explore the characteristics of endocardiac and extracardiac haemodynamics parameters in fetus with thickened nuchal translucency (NT) and analyze the relationship between hemodynamic changes and fetal prognosis.Methods The fetal appearance was observed during the first trimester. And the thickness of NT or soft tissue of neck was quantified. The endocardiac and extracardiac haemodynamic parameters were measured by ultrasound Doppler.The parameters were compared between fetus with thickened NT and normal fetus.Echocardiography was performed individually in both 2nd trimester and newborn stage. Results Eight cases with greater NT thickness were found. Four cases terminated pregnancy during the first or second trimester: one was diagnosed as persistent arterial trunk during a 13-week gestation,one with congenital cystic adenomatoid malformation during second trimester.Both were confirmed by autopsy; one with pleural fluid and ascites while another aborted at the expectant mother's will.Four cases were delivered full-term.Among them,one had congenital anal atresia while the other 3 cases were normal.Endocardiac haemodynamic parameters were normal in all cases with thickened NT and no heart malformaiton.Higher pulsatility index ( PI),resistive index (RI) and ratio of velocity of systole and diastole (S/D) in venous duct were observed in 5 cases.The endocardiac and extracardiac haemodynamics parameters of the cases with thickened NT and complicated with heart malformation were different from normal cases.Conclusion Greater NT thickness is closely correlated with chromosomal abnormalities,congenital cardic defects,other structure abnormalities and a poor prognosis. Ultrasound Doppler can evaluate the fetal heart functions accurately. If abnormal endocardiac and extracardiac parameters are found in fetus with thickened NT,the existence of heart malformation should be considered.When abnormal extracardiac Doppler waveshape or greater blood flow resistance is found with normal endocardiac parameters,prognostic follow-ups should be conducted with chromosomal examinations.