多普勒超声检测缺氧胎儿血流动力学改变的临床价值

The clinical value of hemodynamic changes in fetus with anoxemia detected by Doppler ultrasonography

目的评价胎儿腹主动脉(AA)、肺动脉(PA)、脐动脉(UMA)、颈内动脉(ICA)和升主动脉(AAO)的血流动力学改变与胎儿宫内缺氧的关系。方法采用高分辨率彩色多普勒超声诊断仪检查98例缺氧胎儿及116例非缺氧正常胎儿,测量并计算脐动脉、腹主动脉及颈内动脉血流的收缩期最高速度(Vs)、舒张末期最低速度(Vd)、收缩期速度与舒张期速度的比值(S/D)及阻力指数(RI)。测量升主动脉和肺动脉血流的收缩期峰值速度(PFV)。结果①缺氧胎儿脐动脉和腹主动脉的S/D以及RI明显高于正常胎儿(P<0.01),颈内动脉的S/D和RI则低于正常组(P<0.05);②缺氧胎儿升主动脉与肺动脉的PFV明显低于非缺氧胎儿(P<0.01),并且,肺动脉的PFV降低幅度明显大于升主动脉(P<0.01)。结论通过检测胎儿血流动力学的改变,可了解正常和异常胎儿体内血流动力学的特征,从而为检测胎儿宫内缺氧及心功能状态提供依据。

Objective To evaluate the relationship between intrauterine anoxemia and the hemodynamic changes of fetal abdominal aorta（ AA ）, pulmonary artery（PA）, umbilicalartery （UMA）, internal carotid（ICA） and ascending aorta（AAO）. Methods The subjects consisted of 98 fetuses with anoxemia and 116 controls without anoxemia. The maximum systolic velocity（Vs） and the minimum diastolic velocity（Vd） of AA, PA,UMA and ICA were measured. The resistance index （RI）, Vs/Vd ratio and the systolic peak velocity（PFV） of AAO and PA were recorded. Results ①RI and Vs/Vd ratio of UMA and AA in fetus with anoxemia were significantly higher than those of fetuses without anoxemia （ P 〈 0.01 ）. But those of ICA in anoxemic fetuses were less than those of the control （ P 〈 0.05）. ② PFV of AAO and PA in fetuses with anoxemia were significantly less than those of the control （ P 〈 0.01 ）. Conclusion We can identify the impairment of fetal myocardium and the features of flow distribution in fetuses though hemodynamic changes of fetuses with anoxemia.