胎儿生长受限孕妇脐血流监测与胎儿预后的关系
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摘要
目的探讨胎儿生长受限孕妇脐血流监测与胎儿预后的关系。方法选择2016年1月至2017年1月期间在我院进行产前检查的胎儿生长受限孕妇90例为研究对象,所有孕妇均接受脐动脉血流监测,分析孕妇的脐动脉血流S/D比值、阻力指数(RI),对不同S/D比值孕妇的孕期合并症发生情况以及胎儿预后情况进行对比分析。结果随着孕周的增加,孕妇的脐动脉血流S/D比值逐渐呈现下降趋势,但仍旧较高;其中S/D比值≥3共20例,S/D比值<3共70例;孕妇的RI值为0.58±0.09,与正常值范围比较,明显较高。S/D比值≥3组的妊娠高血压疾病发生率为30.00%、妊娠期糖尿病发生率为30.00%、羊水过少发生率为20.00%、胎盘早剥发生率为10.00%、脐带因素发生率为60.00%,均显著高于S/D比值<3组的8.57%、5.71%、2.86%、0.00%、14.29%,差异具有统计学意义(P<0.05)。S/D比值≥3组的新生儿窒息发生率为30.00%、孕晚期引产发生率为20.00%、胎死宫内发生率为20.00%,均显著高于S/D比值<3组的2.86%、0.00%、0.00%,差异具有统计学意义(P<0.05);两组的剖宫产率比较,差异无统计学意义(P>0.05)。结论监测胎儿生长受限孕妇的脐血流S/D比值,可判断胎儿的血流灌注情况,对评估胎儿预后具有重要价值。
Objective To explore the relationship between umbilical cord blood flow monitoring and fetal prognosis in pregnant women with fetal growth restriction. Methods 90 cases of pregnant women with fetal growth restriction who received prenatal examination in our hospital from January 2016 to January 2017 were selected as research objects. All cases received umbilical cord blood flow monitoring.The S/D ratio of umbilical arterial blood flow and resistance index(RI) were analyzed, and the incidences of maternal pregnancy complications and fetal prognosis of different S/D ratio were compared and anzlyed. Results With the increase of gestational age, the S/D ratio of umbilical arterial blood flow of pregnant women gradually decreased, but it was still higher; Among 90 cases, 20 cases had S/D ratio ≥3,and 70 cases had S/D ratio < 3; The RI value of pregnant women was 0.58 ± 0.09, which was significantly higher than the normal range. The incidences of pregnancy-induced hypertension disease, gestational diabetes, oligohydramnios, placental abruption and umbilical cord factors of pregnant women with S/D ratio ≥3 were 30.00%, 30.00%, 20.00%, 10.00% and 60.00% respectively, significantly higher than 8.57%,5.71%, 2.86%, 0.00% and 14.29% of pregnant women with S/D ratio < 3, respectively(P <0.05). The incidences of neonatal asphyxia,induced labor at late pregnancy and dead fetus in uterus of pregnant women with S/D ratio ≥3 were 30.00%, 20.00% and 20.00%respectively, significantly higher than 2.86%, 0.00% and 0.00% of pregnant women with S/D ratio < 3, respectively(P <0.05); No statistical difference was found between pregnant women with S/D ratio ≥3 and pregnant women with S/D ratio < 3 in the cesarean section rate(P>0.05). Conclusions Monitoring the S/D ratio of umbilical blood flow in pregnant women with fetal growth restriction can determine the blood perfusion of the fetus and is of great value in evaluating fetal prognosis.
Objective To explore the relationship between umbilical cord blood flow monitoring and fetal prognosis in pregnant women with fetal growth restriction. Methods 90 cases of pregnant women with fetal growth restriction who received prenatal examination in our hospital from January 2016 to January 2017 were selected as research objects. All cases received umbilical cord blood flow monitoring.The S/D ratio of umbilical arterial blood flow and resistance index(RI) were analyzed, and the incidences of maternal pregnancy complications and fetal prognosis of different S/D ratio were compared and anzlyed. Results With the increase of gestational age, the S/D ratio of umbilical arterial blood flow of pregnant women gradually decreased, but it was still higher; Among 90 cases, 20 cases had S/D ratio ≥3,and 70 cases had S/D ratio < 3; The RI value of pregnant women was 0.58 ± 0.09, which was significantly higher than the normal range. The incidences of pregnancy-induced hypertension disease, gestational diabetes, oligohydramnios, placental abruption and umbilical cord factors of pregnant women with S/D ratio ≥3 were 30.00%, 30.00%, 20.00%, 10.00% and 60.00% respectively, significantly higher than 8.57%,5.71%, 2.86%, 0.00% and 14.29% of pregnant women with S/D ratio < 3, respectively(P <0.05). The incidences of neonatal asphyxia,induced labor at late pregnancy and dead fetus in uterus of pregnant women with S/D ratio ≥3 were 30.00%, 20.00% and 20.00%respectively, significantly higher than 2.86%, 0.00% and 0.00% of pregnant women with S/D ratio < 3, respectively(P <0.05); No statistical difference was found between pregnant women with S/D ratio ≥3 and pregnant women with S/D ratio < 3 in the cesarean section rate(P>0.05). Conclusions Monitoring the S/D ratio of umbilical blood flow in pregnant women with fetal growth restriction can determine the blood perfusion of the fetus and is of great value in evaluating fetal prognosis.
引文
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[12]何玉梅,宁荣萍,陈红坚,等.围手术期胎儿宫内缺氧的脐血流超声特征评估及其与母体、胎儿氧化应激损伤的关系[J].海南医学院学报,2017,23(5):596-599.
[13]Abdennadher W,Chalouhi G,Dreux S,et al.Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction:criteria for in-utero treatment[J].Ultrasound Obstet Gynecol,2015,46(3):306-311.
[14]赵岩岩,佟丽波,杜佳秋,等.胎儿脐血流监测与胎心监护在预测新生儿结局的临床价值研究[J].齐齐哈尔医学院学报,2016,37(15):1934-1935.
[15]张陈彦,肖学茹,刘慧,等.胎儿脐动脉舒张末期血流缺失与母婴结局的病情观察与分析[J].河北医科大学学报,2016,37(8):975-978.
[16]Liu Y,Bezverbnaya K,Zhao T,et al.Involvement of the HCK and FGR src-family kinases in FCRL4-mediated immune regulation[J].J Immunol,2015,194(12):5851-5860.
[17]张晓威,李璐瑶,史晓明,等.脐血流异常对选择性宫内生长受限代谢组学影响的初步探讨[J].现代妇产科进展,2017,26(8):569-573.
[18]黄超妹,陈向利.孕晚期彩超脐血流S/D比值在高危妊娠结局预测中的价值分析[J].中国医学创新,2016,13(25):24-26.
[19]Park CW,Park JS,Jun JK,et al.Mild to moderate,but not minimal or severe,acute histologic chorioamnionitis or intra-amniotic inflammation is associated with a decrease in respiratory distress syndrome of preterm newborns without fetal growth restriction[J].Neonatology,2015,108(2):115-123.
[20]朱薏,路妍妍,田耕.丹参注射液与低分子肝素治疗胎儿生长受限的临床疗效比较[J].现代医院,2016,16(4):483-485.
[21]许碧秋,蒋小萃,汪莎,等.双胎胎儿各孕周脾脏大小及脐血流变化与双胎围生儿不良预后的临床关系研究[J].中国妇幼保健,2017,32(24):6192-6194.
[2]陈冰,郭蕾,李春东.彩色多普勒超声检测胎儿脐血流在宫内窘迫诊断中的临床价值[J].实用医院临床杂志,2013,10(4):64-66.
[3]任国平,王保莲,毕春燕,等.丹参注射液联合肝素治疗胎儿生长受限的临床疗效及对孕妇血流变的影响[J].世界中医药,2017,12(5):1032-1036.
[4]陈川,杨太珠.晚孕期胎儿脐血流频谱异常孕妇的妊娠结局分析[J/CD].中华妇幼临床医学杂志(电子版),2017,13(4):445-448.
[5]Mazzi P,Caveggion E,Lapinetvera JA,et al.The Src-family kinases Hck and Fgr regulate early lipopolysaccharide-induced myeloid cell recruitment into the lung and their ability to secrete chemokines[J].J Immunol,2015,195(5):2383-2395.
[6]任国平,王保莲,王艳红,等.不同浓度氧综合治疗胎儿生长受限的疗效观察[J].中国保健营养,2016,26(9):66-67.
[7]肖学茹,张陈彦,孙东霞,等.胎儿脐血流监测联合D-二聚体在妊娠结局中的临床意义[J].中日友好医院学报,2016,30(2):90-92.
[8]Medina I,Cougoule C,Drechsler M,et al.Hck/Fgr kinase deficiency reduces plaque growth and stability by blunting monocyte recruitment and intraplaque motility[J].Circulation,2015,132(6):490-501.
[9]王春香,陈静.重度子痫前期伴低蛋白血症及心脏损伤对胎儿脐血流及妊娠结局的影响[J].中国妇幼保健,2017,32(15):3567-3569.
[10]向罗珺,骆祚兰,肖延龄,等.低分肝素治疗早发型和晚发型胎儿生长受限的临床应用[J].现代仪器与医疗,2016,22(1):34-36.
[11]Sakazaki S,Masutani S,Sugimoto M,et al.Oxygen supply to the fetal cerebral circulation in hypoplastic left heart syndrome:a simulation study based on the theoretical models of fetal circulation[J].Pediatr Cardiol,2015,36(3):677-684.
[12]何玉梅,宁荣萍,陈红坚,等.围手术期胎儿宫内缺氧的脐血流超声特征评估及其与母体、胎儿氧化应激损伤的关系[J].海南医学院学报,2017,23(5):596-599.
[13]Abdennadher W,Chalouhi G,Dreux S,et al.Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction:criteria for in-utero treatment[J].Ultrasound Obstet Gynecol,2015,46(3):306-311.
[14]赵岩岩,佟丽波,杜佳秋,等.胎儿脐血流监测与胎心监护在预测新生儿结局的临床价值研究[J].齐齐哈尔医学院学报,2016,37(15):1934-1935.
[15]张陈彦,肖学茹,刘慧,等.胎儿脐动脉舒张末期血流缺失与母婴结局的病情观察与分析[J].河北医科大学学报,2016,37(8):975-978.
[16]Liu Y,Bezverbnaya K,Zhao T,et al.Involvement of the HCK and FGR src-family kinases in FCRL4-mediated immune regulation[J].J Immunol,2015,194(12):5851-5860.
[17]张晓威,李璐瑶,史晓明,等.脐血流异常对选择性宫内生长受限代谢组学影响的初步探讨[J].现代妇产科进展,2017,26(8):569-573.
[18]黄超妹,陈向利.孕晚期彩超脐血流S/D比值在高危妊娠结局预测中的价值分析[J].中国医学创新,2016,13(25):24-26.
[19]Park CW,Park JS,Jun JK,et al.Mild to moderate,but not minimal or severe,acute histologic chorioamnionitis or intra-amniotic inflammation is associated with a decrease in respiratory distress syndrome of preterm newborns without fetal growth restriction[J].Neonatology,2015,108(2):115-123.
[20]朱薏,路妍妍,田耕.丹参注射液与低分子肝素治疗胎儿生长受限的临床疗效比较[J].现代医院,2016,16(4):483-485.
[21]许碧秋,蒋小萃,汪莎,等.双胎胎儿各孕周脾脏大小及脐血流变化与双胎围生儿不良预后的临床关系研究[J].中国妇幼保健,2017,32(24):6192-6194.