1 保定市第一中心医院超声科，河北 保定 071000
目的：采用二维和频谱多普勒超声测量先天性心脏病(congenital heart disease，CHD)胎儿脑沟的深度及脑血流参数，以评估CHD胎儿脑发育情况。方法：选取2016年6月至2018年6月于保定市第一中心医院行产前超声检查，发现复杂型CHD胎儿34例。同时选取同孕周超声检查正常胎儿34例为对照组。分别测量正常组和CHD组胎儿大脑中动脉搏动指数(middle cerebral artery pulsatility index，MCAPI)、脐动脉搏动指数(umbilical artery pulsatility index，UAPI)、脑-胎盘比(cerebroplacental ratio，CPR)、顶枕沟深度、外侧裂深度、距状沟深度，比较两组间各参数的差异。采用新生儿行为神经测定(neonatal behavioral neurological assessment，NBNA)量表评估新生儿脑损伤情况，比较两组间NBNA评分差异，分析二维及频谱超声各参数测值与NBNA评分的相关性。结果：CHD组胎儿MCAPI，UAPI，CPR，顶枕沟深度，外侧裂深度，距状沟深度与正常组比较差异有统计学意义(P<0.05)；正常组与16例CHD组新生儿NBNA评分比较差异有统计学意义(P<0.05)；二维及频谱超声各参数测值与NBNA有一定的相关性(P<0.05)。结论：超声不仅能对CHD胎儿心内结构畸形做出明确诊断，还能通过脑沟回及脑血流参数的测量来评估胎脑发育情况，为CHD胎儿转归提供临床依据。关键词： 先天性心脏病；胎儿；频谱多普勒；超声；脑沟回
Ultrasound evaluating the brain development of fetuses with complex congenital heart disease
CorrespondingAuthor: WANG Yuanyuan Email: email@example.com
Foundation: This work was supported by Baoding Science and Technology Planned Project, China (2041ZF086).
Objective: To evaluate the development of fetal brain in complex congenital heart disease (CHD) by two-dimensional and spectral doppler ultrasound measuring the depth of cerebral sulcus and cerebral blood flow parameters in fetuses with CHD. Methods: A total of 34 cases of abnormal fetuses who underwent ultrasound examination in Baoding No. 1 Central Hospital from June 2016 to June 2018 were selected. Thirty-four normal fetuses with the same gestational age were selected as the normal group. The fetal middle cerebral artery pulsatility index (MCAPI), umbilical artery pulsatility index (UAPI), cerebroplacental ratio (CPR), depth of parietooccipital sulcus, depth of sylvian fissure, depth of calcarine sulcus of the two groups were measured, and the differences of each parameter among the two groups were compared. The neonatal behavioral neurological assessment (NBNA) score was used to evaluate neonatal brain injury, the differences of NBNA score between two groups were compared, the correlation between each parameter and NBNA score were analyzed. Results: There were significantly statistical differences in MCAPI, UAPI, CPR, depth of parietooccipital sulcus, depth of sylvian fissure and depth of calcarine sulcus between CHD group and normal group; The difference of NBNA score between two groups were statistically significant, there was a certain correlation between each parameter and NBNA (P<0.05). Conclusion: Ultrasound can not only make a definite diagnosis of intracardiac malformation of CHD fetus, but also evaluate fetal brain development by measuring cerebral sulcus and cerebral blood flow parameters, thus providing a clinical basis for the prognosis of CHD fetus.Keywords： congenital heart disease; fetus; spectral Doppler; ultrasound; sulci and gyrus