胎儿心电图 (FECG) 一围保发展历史 Perinatal health care history 1. 听胎心音 fetal heart sounds 2. 胎心仪 fetus-voice meter 3. 胎儿监护仪 Fetal Monitor 4. 胎儿心电图 fetal electroc

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1 胎儿心电图临床应用 Clinical Application of Fetal Electrocardiogram Zhengzhou, China 中国. 郑州. 郑州大学第二附属医院心电图科李中健 LI Zhong-jian 1

2 胎儿心电图 (FECG) 一围保发展历史 Perinatal health care history 1. 听胎心音 fetal heart sounds 2. 胎心仪 fetus-voice meter 3. 胎儿监护仪 Fetal Monitor 4. 胎儿心电图 fetal electrocardiogram 二 GY-EXPL 胎儿心电图机 Fetal electrocardiograph 1. 硬件 Hardware 2. 软件 Software 3. 特点与优势 Features and advantages 4. 临床意义 Clinical Significance 2

3 一围保发展历史 Perinatal health care history 1. 听胎心音 Listen to the fetal heart sounds: 1620 年有人已听到胎心 1820 年发明听诊器应用于临床 2. 胎心仪 fetus-voice meter: 利用多普勒原理检测胎心音信号, 采用超声频率 ( 一般 1~5 MHz), 从而产生胎心仪, 计算胎心率 3

4 胎心仪 fetus-voice meter 胎心率连续的心率变化曲线宫缩压 Fetal heart rate, continuous heart rate variability curve, uterine contraction pressure 4

5 3. 胎儿监护仪的优缺点 The Advantages And Disadvantages of Fetal Monitor 优点 Advantages 是一种无损检测方法, 临床上容易接受 ; 使用起来简单方便缺点 Disadvantages 由于胎儿心脏很小, 不易被超声束射中, 加上胎儿在羊水中自由活动容易使胎儿监护仪的多数信号丢失 ; 超声发射需要一定的能量, 属于有源检测手段, 会对胎儿产生一定的影响, 虽然目前还不清楚其影响的程度, 但临床应用有一定的限制, 如 :5 个月之后才能进行超声多普勒检查, 每月使用的次数不得超过 3 次 5

6 4. 胎儿心电图 (FECG) 胎儿可以做心电图吗 Could the fetal do electrocardiogram? 胎儿心脏在跳动之前先产生电活动, 胎儿心脏的电活动经胎体组织和母体内脏组织传导至母体的体表应用胎儿心电图机把传到母体腹壁上的胎儿心电活动记录下来, 就是胎儿心电图 FECG shows the fetal electrical activity which was generated before the fetal heart beat and transmit to the mother skin through the fetal/ mother organ and tissue. 6

7 优点 Advantages 可测出胎心率 ; To measure the fetal heart rate 可观察胎儿心电波形微变化 ; To observe micro-change of waveform of the fetal ECG 可了解胎儿心脏电学改变 ; To know the fetal cardiac electrical changes 更能反映胎儿在宫腔内的生理及病理情况 To reflect the physiological and pathological situation of the fetus in the womb 7

8 胎儿心电图在不同孕期作用 The function of FECG in different pregnancy 早中孕期 (3-7 个月 ) 可用于先天性心脏病或心脏畸形的筛查 ; Screening of congenital heart disease or heart deformity in the early pregnancy(3-7 months) 晚期妊娠 (8-10 个月 ) 可以及早发现胎儿宫内缺氧窘迫 Detection of fetal intrauterine hypoxia and distress in the late pregnancy(8-10 months) 二者可以为临床治疗提供重要依据, 从而降低围产儿发病率及病死率, 提高围产儿出生质量, 达到优生及提高民族素质的目的 The function in the pregnancy provides important basis for clinical treatment, so the incidence and mortality will decrease,the quality of the perinatal will be improved. 下面将我们近年在媒体撰写的胎儿心电图科普论文介绍如下 Papers about FECG for media in recent years as follows 8

9 Fetal can also do electrocardiogram 9

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11 胎儿应该经常做心电图 Fetus should usually do the ECG 早搏, 有些是从娘胎中带出来的, 出生后已经没有治疗价值经过近二十年的胎儿心电图检查, 发现胎儿期有早搏, 出生后仍然有早搏, 因此建议准父母若能在宝宝出生前为其多做几次胎儿心电图, 便可防患于未然见下述举例 for example 11

12 举例一 : 孕期描记 : 孕 28 周检查胎儿心律不齐, 行 FECG 检查发现 : 胎心率 150 次 / 分, 其中较大的波形 RSr 为母亲心室波 (M), 较小的窄 r 波为胎儿心室波 (F), 其间提前发生稍宽大畸形, 且代偿间期完全的 r 波形为频发胎儿室性早搏 (F ) Record during the 28-week pregnancy. Fetal arrhythmia was found at 28 gestational weeks,fecg revealed:fetal heart rate: 150bpm. The mother ventricular waves (M) show as big RSr ; The normal fetal waves (F) show as narrow r; The waves (red marker, F ') occurs in advance, slightly wider and with completely compensatory interval were frequent fetal ventricular premature beats. 12

13 出生后描记 : 新生儿心电图, 窦性心律, 频发室性早搏二联律 Record after birth. Neonatal ECG, Sinus rhythm, frequent premature ventricular contractions bigeminy. 13

14 举例二 : 2-1 孕妇 28 岁宫内孕 W 孕期描记 : 胎儿心电图 Pregnant woman, 28-year-old, FECG recorded during the 40-week and 4 day pregnancy. F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F 14

15 2-2 孕妇 28 岁宫内孕 W 孕期描记 : 胎儿心电图 Pregnant woman, 28-year-old, FECG recorded during the 40-week and 6 day pregnancy. F F F F F F F F F F F F F F F F F F F F F F F F 15

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17 2-4 Ⅰ 出生后描记 : 新生儿心电图, 窦性心律, 频发室性早搏 Record after birth: Neonatal ECG,Sinus rhythm,frequent premature ventricular contractions( ). Ⅱ Ⅲ 17

18 Do a FECG monthly after 3 months pregnant. 18

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21 二 GY-EXPL 胎儿心电图机华南医电 21

22 临床意义 Clinical significance 特点与优势 Features and advantages 软件 Software 硬件 Hardware 22

23 胎儿心电图机共六根心电导联线 There are 6 lead wires in the FECG machines 一个胸部导联电极 ( 红色 ), 作为分离出胎儿心电的参考电极 ;One chest lead electrode (red color) as the reference electrode isolated from fetal heart 三个腹部导联电极 ( 棕色蓝色橙色 ), 用来采集母体和胎儿的混合心电信号 ;Three abdominal lead electrodes (brown blue orange color) are used to collect the mixed signals of the mother and fetus 一个公共端电极 ( 绿色 ), 作为胸部和腹部导联电极的公共端 ;one common electrode (green) as the common port of chest and the abdominal electrode 一个接地电极 ( 黑色 ), 作为接地端 A grounding electrode (black) serves as earth terminal 22

24 电极位置 location of the electrodes 胸导电极 V( 红色 )- 放置在母亲胸导联 V5 的位置 chest lead electrode V(red) -The site of V5 on mother s chest 腹导电极 P1( 棕色 )- 放置在左边耻骨联合处或左横位 abdominal lead electrode P1(brow) -Left symphysis or left sacrotransverse 腹导电极 P2( 蓝色 )- 放置在耻骨联合中线处或头位或臀位 abdominal lead electrode P1(blue) Middle of the pubic symphysis or cephalic presentation or pelvic presentation 24

25 电极位置 location of the electrodes 腹导电极 P3( 橙色 )- 放置在右边耻骨联合处或右横位 abdominal lead electrode P3 (orange color) -Right symphysis or right transverse presentation 公共端电极 C( 绿色 )- 放置在宫底位置 common electrode C (green color) fundus 接地电极 N( 黑色 )- 放置在右腋中线下侧最下面两肋间隙 grounding electrode (black color) Right axillary line on the last intercostal space 24

26 临床意义 Clinical significance 特点与优势 Features and advantages 硬件 Hardware 软件 Software 26

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30 胎儿心电图识别 30

31 临床意义 Clinical Significance 软件 Software 硬件 Hardware 特点与优势 Features and Advantages 31

32 GY-EXPL 胎儿心电图机优势在于 : The advantages of FECG 1. 三通道母胎混合信号, 最大程度提高胎儿心电信号的检出率 Improve the detection rate of fetal heart signal extremely through triple channel mother-fetal mixed signal 2. 对病例信息进行数据库式管理 Manage the information of cases by database 32

33 特点与优势 Features and Advantages 1. 非侵入无创 non-invasive 2. 数据库式管理 manage by database 3. 检出率 95% 以上 detection rate >95% 4. 三通道母胎混合 triple channel mother-fetalmixed signal 周以后即可 applicable after12 weeks

34 与胎儿监护仪对比 compare with fetal monitor 仪器名称 instrument 原理 principle 检测内容 test content GY-EXPL 胎儿心电图机 FECG 通过采集人体的电信号, 经过滤波处理后在电脑屏幕上显示出来 Collect the electric signal,filter processing and then display on the computer screen. 检测胎儿心电 electrocardiac activity of fetus 胎儿监护仪 fetal monitor 利用超声的多普勒效应, 根据胎心音信号计算出心率, 形成胎监 Heart rates are calculated by the fetal heart signal acquired with the Ultrasonic doppler effect. 主要检测胎动和宫内压力 fetal movement and Intrauterine pressure 34

35 仪器名称 instrument 安全程度 security GY-EXPL 胎儿心电图机 FECG 直接采集人体的电信号, 不对人体发射任何物质, 属于绝对安全的 It is absolutely safe because the machine collect the body signal without anything emission 胎儿监护仪 fetal monitor 通过对人体发射一定剂量的超声波, 通过计算反射波得出结果, 其安全程度取决于对人体发射超声波的剂量, 剂量越大对人体的伤害越大, 只有把超声的剂量控制在一定的范围内才可以认为是安全的 The security depended on the dose of the ultrasound,the more the ultrasound, the bigger the harm. It is considered to be safe in certain range 34

36 分析结果 Result GY-EXPL 胎儿心电图机安全无创, 可以反复使用, 更加呵护母婴健康! The GY-EXPL fetal electrocardiograph is safe,noninvasive and repeatable,it is more beneficial for the mother and fetus. 36

37 特点与优势 Features and Advantages 软件 Software 硬件 Hardware 临床意义 Clinical Significance 37

38 临床意义 clinical significance GY-EXPL 胎儿心电图机主要适用于孕期和产前筛检和监护, 尤其适用于高危妊娠的监护, 更好的保护母婴健康 The GY-EXPL fetal electrocardiograph mainly apply to the screening and mo nitoring of pregnancy and prenatal, especially high risk pregnancy. 正常胎儿心率较正常成人心率快, 为次 / 分钟 The normal fetal heart rate is per minute,which is faster than adult. 38

39 胎儿心电图是一门跨学科的生物医学工程科学, 包括产科心血管科等 ; 胎儿心电图应用于产前诊断和监护, 可以提高对胎儿监测的质量, 达到及早以及优生优育的目的 ; 通过对胎儿心电图进行研究, 可以判断胎儿在宫内的生长发育状况, 发现胎儿在妊娠期或分娩期缺氧及其他病理情况, 还可以尽早的发现胎儿先天性心脏病 FECG is a transdisciplinary biomedical engineering science, including obstetrics, cardiovascular and so on; the application of FECG in prenatal diagnosis monitoring can improve the monitoring quality and prevent the fetal disease. We can learn about the growth and development situation, fetal hypoxia and other pathological conditions during pregnancy or childbirth and also find congenital heart disease as soon as possible with the FECG research. 39

40 胎儿心动过速 Fetal tachycardia 胎儿心动过缓 Fetal bradycardia 胎儿心律不齐 Fetal arrhythmias 胎心率 >160 次 / 分称胎儿心动过速,>180 次 / 分为心率明显过速是早期胎儿窘迫的征兆胎心率 <120 次 / 分称胎儿心动过缓, <100 次 / 分为显著胎儿心动过缓, 可为胎儿进行性缺氧的表现变化范围超过次 / 分钟, 是胎儿窘迫的征兆 Fetal tachycardia:fetal heart rate > 160 bpm, obvious fetal tachycardia: Fetal heart rate > 180 bpm It is an early sign of fetal distress. Fetal bradycardia:fetal heart rate<120bpm, obvious fetal bradycardia: <100 bpm It is the performance of fetal progressive hypoxia. The variation range exceeded bpm. It is the sign of fetal distress 40

41 胎心期前收缩 Fetal premature beat 胎心传导阻滞 Fetal heart block FQRS 时限增宽或缩短 FQRS widened or or shortened FQRS 综合波提前出现为期前收缩, 又称早搏, 其后的 R-R 间期较正常 R -R 间期延长, 称为期前收缩后代偿间歇 FQRS complex wave appeared in advance, also known as premature beat, the subsequent RR interval is longer than normal, and is called compensatory pause. FECG 显示胎心率缓慢而规则, 慢至 70~80 次 / 分以下, 可伴 FQRS 波增宽畸形, 孕期随访 FECG 持续不变, 但不伴有其他胎儿窘迫症状 FECG shows FHR is slow and regular, down to 70 to 80 bpm or less, may be associated with wide and malformed FQRS. Pregnancy follow-up FECG stayed unchanged, but not accompanied by other symptoms of fetal distress. 正常 FQRS 时限为 0.02~0.05s, 其值与胎儿体重及胎龄正相关 FQRS 时限 0.06s 为 QRS 时限增宽 FQRS normal time limit is 0.02 ~ 0.05s, whose value is related to fetal weight and gestational age. FQRS 0.06s time as QRS duration widen 41

42 FQRS 幅值增大 FQRS amplitude increase 双胎 didymous 羊水较少时 FQRS 振幅较大, 特别过期妊娠或 IUGR 时, 若伴有 FQ RS 振幅较大, 特别需注意是否有羊水过少 FQRS amplitude is higher when there are fewer amniotic fluid, especially prolonged pregnancy or IUGR, We especially should pay attention to whether there is little amniotic fluid when accompanied by FQRS higher amplitude. 胎儿心电图中, 可见两组 FQRS 综合波, 形态有微小差异 Fetal electrocardiogram showed two slight different FQRS integrated wave 42

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47 母亲心率 :100 次 / 分, 正常 ;Mother heart rate:100bpm,normal 胎儿心率 : 从 130 次 / 分到 176 次 / 分周期性变化异常, 为二度 Ⅰ 型窦房阻滞 ( 传导比例 3:2, 有典型文氏周期 ) Fetal heart rate:change periodically from 130bpm to 176bpm. Abnormal, Second-degree Type 1 sinus atrial block( conduction ratio 3:2, with typical Wenckebach cycle) 47

48 双胎 -1 48

49 双胎 -2 Didymous FECG-2 Mother heart rate:65bpm,normal Fetal heart rates:150bpm,143bpm,both normal 49

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2014年1月A 1期排版.FIT)

2014年1月A 1期排版.FIT) 第 26 卷第 15 期中国现代医学杂志 Vol. 26 No.15 2016 年 8 月 China Journal of Modern Medicine Aug. 2016 DOI: 10.3969/j.issn.1005-8982.2016.15.022 文章编号 : 1005-8982(2016)15-0114-05 声检查对产前出血病因诊断的

胎儿心电图 (FECG) 一 围保发展历史 Perinatal health care history 1. 听胎心音 fetal heart sounds 2. 胎心仪 fetus-voice meter 3. 胎儿监护仪 Fetal Monitor 4. 胎儿心电图 fetal electroc

胎儿心电图 (FECG) 一围保发展历史 Perinatal health care history 1. 听胎心音 fetal heart sounds 2. 胎心仪 fetus-voice meter 3. 胎儿监护仪 Fetal Monitor 4. 胎儿心电图 fetal electroc