胎儿先天性心脏病对宫内尿生成率的影响

Objectives: To evaluate the influence of congenital heart disease (CHD) or congestive heart failure (CHF) on fetal urine production rate (UPR) and to establish normal reference intervals. Methods: A cross-sectional study was performed on normal fetuses (n=314) and on fetuses with CHD (n=49). CHD cases were divided into groups on the basis of heart function as defined by Huhta score: with CHF (n=11) and without CHF (n=38). Fetal bladder volume was measured by two-dimensional as well as three-dimensional ultrasound with the Virtual Organ Computer-aided Analysis technique. Results: In normal fetuses, UPR increased with gestational age from a mean value of 4.5mL/h at 21weeks to 66.5mL/h at 40weeks. There were no significant differences in UPR between CHD cases without CHF and controls (P=0.581). However, fetuses with CHF had decreased UPR values (Controls vs. CHF, P="0".007) compared with the controls. The interobserver and intraobserver variability for assessment of UPR was better using three-dimensional rather than two-dimensional US. Conclusions: Fetal UPR can be reproducibly measured by the Virtual Organ Computer-aided Analysis technique. It appears that heart function, rather than CHD, affects fetal UPR. Fetal UPR may therefore be an additional indicator of CHF.