陈禹舒　姜凡　谭捷　顾莉莉　罗平　梁婧　徐晓薇

摘要：目的  探討Tei指数评估先天性心脏病（CHD）胎儿左心室功能的应用价值。方法  收集2017年6月～2018年10月于我院经胎儿超声心动图诊断为CHD胎儿44例作为病例组，根据心胸面积比值大小分为心胸比正常（n=29）和心胸比增大（n=15）;另选取同期同孕龄正常妊娠胎儿60例作为正常对照组。利用M型超声心动图和脉冲多普勒观察所有胎儿左室短轴缩短率（LVFS）、左室射血分数（LVEF），二尖瓣口E/A值及左心室的Tei指数（LVTei）。结果  病例组胎儿LVEF低于正常对照组胎儿，LVTei高于正常对照组胎儿，差异有统计学意义（P<0.05）;两组胎儿LVFS、E/A比较，差异无统计学意义（P>0.05）。病例组中心胸比正常胎儿LVTei高于正常对照组，差异有统计学意义（P<0.05）;病例组中心胸比正常胎儿与正常对照组LVEF、LVFS及E/A比较，差异无统计学意义（P>0.05）。病例组中心胸比增大胎儿LVTei高于心胸比正常及正常对照组胎儿，LVEF、LVFS及E/A低于心胸比正常及正常对照组胎儿，差异有统计学意义（P<0.05）。结论  Tei指数测量方法简单，可重复性强，可作为评估CHD胎儿左心功能的指标，为早期评估患儿预后提供可靠依据，并指导患儿围产期的治疗。

关键词：Tei指数;先天性心脏病;心胸面积比值;胎儿心功能

中图分类号：R541.1                                 文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2019.14.027

文章编号：1006-1959（2019）14-0087-04

Abstract：Objective  To investigate the application value of Tei index in evaluating left ventricular function in congenital heart disease （CHD）. Methods  From June 2017 to October 2018， 44 cases of CHD fetus were diagnosed as fetal cases by fetal echocardiography. According to the ratio of cardiothoracic area， the cardiothoracic ratio was normal （n=29） and the ratio of cardiothoracic ratio was increased（n=15）; 60 cases of normal pregnancy with the same gestational age were selected as the normal control group. All fetal left ventricular short axis shortening rate （LVFS）， left ventricular ejection fraction （LVEF）， mitral valve E/A value， and left ventricular Tei index （LVTei） were observed using M-mode echocardiography and pulsed Doppler.Results  The fetal LVEF in the case group was lower than that in the normal control group， and the LVTei was higher than that in the normal control group，the difference was statistically significant （P<0.05）. There was no significant difference in the LVFS and E/A between the two groups （P>0.05）. In the case group， the central chest was higher than the normal fetus LVTei than the normal control group，the difference was statistically significant （P<0.05）. There was no significant difference between the normal group and the normal control group LVEF， LVFS and E/A （P>0.05）. In the case group， the chest height ratio of the fetus was higher than that of the normal and normal control group. The LVEF， LVFS and E/A were lower than those of the normal and normal control group，the difference was statistically significant （P<0.05）.Conclusion  The Tei index measurement method is simple and reproducible. It can be used as an index to evaluate the left ventricular function of CHD， provide a reliable basis for early assessment of the prognosis of children， and guide the treatment of perinatal period.

Key words：Tei index;Congenital heart disease;Ratio of cardiothoracic area;Fetal heart function

先天性心臟病（congenital heart disease，CHD）目前是我国出生缺陷病种中发病率最高的一种，胎儿期部分严重心脏结构异常会对胎儿或新生儿造成严重后果[1]。胎儿超声心动图检查在对胎儿心脏结构畸形进行判断的同时，还可以测量心功能指标评估胎儿的心功能状态。Tei指数即心肌做功指数，是一种定量评估心脏整体功能的无创性方法[2]。本研究对2017年6月～2018年10月我院就诊的44例CHD胎儿进行胎儿超声心动图检查，探讨Tei指数在评估CHD胎儿左心功能的应用价值，现报道如下。

1资料与方法

1.1一般资料  收集2017年6月～2018年10月在安徽医科大学第二附属医院经胎儿超声心动图诊断CHD的中孕期胎儿44例作为病例组，其中心胸面积比值≤0.35为心胸比正常（n=29），心胸面积比值>0.35为心胸比增大（n=15）。另……