超声检测动脉搏动指数及静脉导管分流率在预测胎儿宫内窘迫出生结局中的价值
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摘要
目的探讨超声检测胎儿脐动脉(umbilical artery,UA)、肾动脉(renal artery,RA)、大脑中动脉(middle cerebral artery,MCA)的搏动指数(pulsation index,PI)及静脉导管(ductus venosus,DV)分流率预测胎儿宫内窘迫出生结局的应用价值。方法选取2013年4月至2018年4月济宁医学院附属医院确诊胎儿宫内窘迫孕妇89例,以出生后1 min Apgar评分为标准分为正常组A组(17例)、轻微异常B组(32例)和明显异常C组(40例)。彩色多普勒超声检测胎儿UA、RA和MCA的PI值,测量胎儿脐静脉(umbilical vein,UV)及DV血流量,计算静脉导管分流率(Q_(DV)/Q_(UV)),对结果进行对比分析。结果 UA和MCA的PI值3组比较,差异均有统计学意义(P<0.05);Q_(DV)/Q_(UV),C组分别与A组和B组比较,差异有统计学意义(P<0.05),A组和B组比较,差异无统计学意义(P>0.05);RA的PI值,B组和C组分别与A组比较,差异有统计学意义(P<0.05),B组和C组比较差异无统计学意义(P>0.05)。结论彩色多普勒超声监测UA、MCA、RA的PI值及Q_(DV)/Q_(UV)能够不同程度预测胎儿宫内窘迫的出生结局。
Objective To explore the value of ultrasound in predicting fetal birth outcomes in intrauterine distress by detecting umbilical artery(UA),renal artery(RA),middle cerebral artery(MCA) pulsation index(PI) and ductus venosus(DV) shunt rate. Methods 89 pregnant women with intrauterine fetal distress diagnosed in Affiliated Hospital of Jining Medical College from April 2013 to April 2018 were selected. Divided them into three groups according to 1 minute Apgar score, including group A of normal group(17 cases),group B of mild abnormal group(32 cases) and group C of apparent abnormal group(40 cases). Doppler flow ultrasound was used to examine the PI of fetal UA,RA,and MCA,and ratio of DV blood flow and umbilical venous(UV) blood flow volume(Q_(DV)/Q_(UV)) and the results were compared and analyzed within 3 groups. Results For PI values of UA and MCA,there were significant differences between group A,group B and group C(P<0.05). For Q_(DV)/Q_(UV),there was significant difference between group C and group A,group C and group B,respectively(P<0.05),while there was no significant difference between group A and group B(P>0.05). For PI values of RA,there was significant difference between group B and group A,group C and group A,respectively(P<0.05),while there was no significant difference between group B and group C(P>0.05). Conclusion PI of fetal UA,RA,and MCA,and Q_(DV)/Q_(UV) by color Doppler ultrasound could predict the birth outcome of fetal distress to varying degrees.
Objective To explore the value of ultrasound in predicting fetal birth outcomes in intrauterine distress by detecting umbilical artery(UA),renal artery(RA),middle cerebral artery(MCA) pulsation index(PI) and ductus venosus(DV) shunt rate. Methods 89 pregnant women with intrauterine fetal distress diagnosed in Affiliated Hospital of Jining Medical College from April 2013 to April 2018 were selected. Divided them into three groups according to 1 minute Apgar score, including group A of normal group(17 cases),group B of mild abnormal group(32 cases) and group C of apparent abnormal group(40 cases). Doppler flow ultrasound was used to examine the PI of fetal UA,RA,and MCA,and ratio of DV blood flow and umbilical venous(UV) blood flow volume(Q_(DV)/Q_(UV)) and the results were compared and analyzed within 3 groups. Results For PI values of UA and MCA,there were significant differences between group A,group B and group C(P<0.05). For Q_(DV)/Q_(UV),there was significant difference between group C and group A,group C and group B,respectively(P<0.05),while there was no significant difference between group A and group B(P>0.05). For PI values of RA,there was significant difference between group B and group A,group C and group A,respectively(P<0.05),while there was no significant difference between group B and group C(P>0.05). Conclusion PI of fetal UA,RA,and MCA,and Q_(DV)/Q_(UV) by color Doppler ultrasound could predict the birth outcome of fetal distress to varying degrees.
引文
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[2] 刁纯青,许庆松.胎儿宫内窘迫的彩色多普勒血流显像研究 [J].中国实用医药,2010,5(9):77-79.
[3] 张春雨,李蕊,张大程,等.脐血血气分析在早产儿窒息诊断中的价值及影响因素分析 [J].中国妇幼保健,2017,32(5):968-971.
[4] 韩华,吴焕卿,李建玲,等.胎心监护联合肾动脉、大脑中动脉及静脉导管分流率预测胎儿宫内窘迫的价值 [J].中国妇幼保健,2014,29(3):473-474.
[5] 龚逞英.胎心监护联合肾动脉、大脑中动脉及静脉导管分流率预测胎儿宫内窘迫的临床分析 [J].中国当代医药,2014,21(26):69-71.
[6] 乐杰.妇产科学 [M].第7版.北京:人民卫生出版社,2008:135-136.
[7] VANDEN W J,GROENENBERG I A,WLADIMIROFF J W,et al.Cerebral doppler ultrasound of the human fetus[J].British Journal of Obstetrics and Gynaecology,1989,96 (7):845-849.
[8] MARI G,DETER R L.Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses [J].American Journal of Obstetrics and Gynecology,1992,166 (4):1262-1270.
[9] 廖伟增,蔡敏娴,汤彬敏,等.孕晚期多普勒超声检测静脉导管预测宫内窘迫胎儿结局的临床价值 [J].医学影像学杂志,2014,24(5):812-815.
[10] 严英榴,杨秀雄,沈理.产前超声诊断学 [M] .北京:人民卫生出版社,2003:491-500.
[11] 梁晓冰,石波,贺玉梅.彩色多普勒超声监测胎儿肾动脉血流对宫内窘迫的预测作用及价值 [J].医学影像学杂志,2016,26(12):2284-2287.
[12] 熊德庆,伍文霞,徐永莲,等.静脉导管多普勒超声检查在预测宫内窘迫胎儿不良出生结局中的应用 [J].世界最新医学信息文摘,2015,15(6):129-130.
[13] 吴娥玲,张玲玲,巨青晖,等.脐动脉血血气pH值与Apgar评分在新生儿窒息诊断中的比较研究 [J].中国优生与遗传杂志,2017,25(9):82-84.