监测胎儿脐动脉、大脑中动脉血流阻力指数预测胎儿宫内窘迫宫内缺氧的价值分析

Value of prediction of intrauterine hypoxia in fetal distress by monitoring fetal umbilical artery,middle cerebral artery and umbilical vein blood flow resistance index

摘要:

目的探讨胎儿脐动脉(UA)、大脑中动脉(MCA)血流阻力指数预测胎儿宫内窘迫宫内缺氧的价值。方法选择2017年6月至2019年6月在开封市妇产医院妇产科接受产检的150例胎儿宫内窘迫产妇作为观察组,另选择同期正常产妇150例为对照组进行研究。采用GE Voluson E8 Expert彩色多普勒超声诊断仪,监测胎儿UA及MCA血流阻力指数,并分析各指数的变化与胎儿宫内窘迫宫内缺氧的关系。结果对照组150例,其中147例Apgar评分为10分,2例9分,1例8分,无评分低于7分者,在出生5 min后9分及8分新生儿评分均升高至10分,观察组新生儿出生1 min者Apgar评分均在7分及以下,两组比较差异有统计学意义(P<0.05)。观察组UA的搏动指数(PI)、阻力指数(RI)、脐静脉内收缩期的峰值流速与舒张期最低值流速的比值(S/D)值均明显高于对照组,差异均有统计学意义(P<0.05)。但观察组MCA的PI、RI、S/D值却均明显低于对照组,差异也均有统计学意义(P<0.05)。随着孕周的增加,观察组胎儿UA的PI、S/D值无明显变化趋势,差异无统计学意义(P>0.05),但RI值会随着孕周的增加而减小(P<0.05)。观察组胎儿MCA的PI值会随着孕周的增加而增加,差异有统计学意义(P<0.05),但是RI、S/D值会随着孕周的增加而减小,差异有统计学意义(P<0.05)。结论彩色多普勒超声监测胎儿UA及MCA血流阻力,可明显显示当胎儿发生宫内窘迫宫内缺氧时各阻力指数的显著变化,对胎儿宫内情况能做一个良好的反映,为临床措施的采取及预后的评估提供一个重要依据。

关键词:脐动脉;大脑中动脉;脐静脉;宫内窘迫;宫内缺氧

Abstract:

【Objective】To explore the value of blood flow resistance index of fetal umbilical artery(UA)and middle cerebral artery(MCA)to predict intrauterine hypoxia in fetal distress.【Methods】From June 2017 to June 2019,150 women with intrauterine distress accepted prenatal examination in the obstetrics and gynecology department of our hospital were selected as the observation group,and 150 normal puerperas in the same period were selected as the control group.The GE Voluson E8 Expert color Doppler ultrasound system was used to monitor the fetal UA and MCA blood flow resistance indexes,and analyze the relationship between the changes of each index and intrauterine hypoxia in fetal distress.【Results】There were 150 cases in the control group,including 147 Apgar scores of 10 points,2 cases of 9 points,1 case of 8 points,no score below 7 points,5 minutes after birth,neonatal scores of 9 and 8 points increased to 10 points;in the observation group,1 minute after birth,the Apgar scores of newborns were all 7 or less,and the difference between the two groups was statistically significant(P<0.05).The PI,RI and S/D values of UA in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).However,the PI,RI and S/D values of MCA in the observation group were significantly lower than those in the control group,and the differences were also statistically significant(P<0.05).With the increase of gestational age,PI and S/D values of UA in the observation group had no significant change trend,the difference was not statistically significant(P>0.05),but RI value would decrease with the increase of gestational age,the difference was statistically significant(P<0.05).PI value of MCA in the observation group increased with the increase of gestational age,and the difference was statistically significant(P<0.05),but RI and S/D value decreased with the increase of gestational age,and the difference was statistically significant(P<0.05).【Conclusion】Color Doppler ultrasound monitoring of fetal UA and MCA blood flow resistance can obviously show significant changes of each resistance index when fetal distress and intrauterine hypoxia occured and be a good reflection of the fetal state,and it can be used as a basis for the clinical measures and the evaluation of prognosis.

Key words:umbilical artery;middle cerebral artery;umbilical vein;intrauterine distress;intrauterine hypoxia