高危妊娠胎儿心脏和外周血液动力学的变化

Central and peripheral hemodynamic changes in fetuses of high risk pregnant

目的研究高危胎儿心脏和外周血液动力学变化及评价彩色多普勒超声检查在围生儿监护中的价值。方法用彩色多普勒超声技术对64例高危胎儿组和14例围生儿死亡组的胎儿心脏水平(主动脉、肺动脉)和外周血管(脐动脉、大脑中动脉)的最大血流速度波形进行分析,并与同期78例正常妊娠胎儿比较。结果与正常组比较,高危胎儿脐动脉阻力增加,肺动脉峰值速度、流速积分×胎心率、右心输出量均明显降低,大脑中动脉阻力无变化;在围生儿死亡组脐动脉阻力指数更为增高,大脑中动脉阻力明显降低,主、肺动脉峰值速度,流速积分×胎心率,左、右心输出量均显著下降。结论评价高危胎儿心脏和外周血液动力学变化,对预测胎儿宫内缺氧具有较大的准确性及实用价值。

Objective To study hemodynamic changes in central and peripheral blood vessels of high risk pregnant fetuses and to evaluate the value of color Doppler ultrasound examination in perinatal monitoring.Methods The color Doppler ultrasound results of maximum flow velocity waveforms at the cardiac level (aorta,pulmonary artery)and the peripheral level(fetal umbilical artery, middle cerebral artery) in 64 cases with high risk pregnant and 14 cases with perinatal mortality were retrospectively analyzed, and compared with 78 normal pregnancies with the same gestational age.Results Pulmonary artery peak velocities,velocity time integral ×heart rate and right cardiac output in high risk pregnant fetuses were significantly lower than that in normal pregnant group(P<0.05),there were no changes of flow waveforms in middle cerebral artery and aorta. In perinatal mortality group,the resistance index of fetal umbilical artery raised significantly and the resistance index of middle cerebral artery declined significantly(P<0.01),aorta and pulmonary artery peak velocities,velocity time integral ×heart rate and right cardiac output declined significantly(P<0.05).Conclusion Evaluation of hemodynamic changes in central and peripheral blood vessel of high risk pregnant fetuses have more accuracy and practical value in predicting fetal distress in uterus.