妊娠肝内胆汁淤积症患者胎儿大脑中动脉血流检测及其分析

Fetal middle cerebral artery blood flow detection and analysis about the patients of intrahepatic cholestasis of pregnancy(IPC)

目的运用彩色多普勒超声监测妊娠肝内胆汁淤积(ICP)胎儿大脑中动脉(MCA)血流动力学变化,预测围产儿预后不良。ICP孕妇血清肝功能试验指标和胆汁酸的变化与围产儿预后不良的相关性。方法运用彩超监测其胎儿MCA平均血流速度(Vm),收缩期血流速度与舒张末期血流速度比值(S/D),博动指数(PI),阻力指数(RI)。ICP孕妇又按胆汁酸、谷丙转氨酶、谷草转氨酶、总胆红素、间接胆红素值的不同分为A、B、C、D四组。结果①ICP患者胎儿MCA的Vm较正常孕妇组胎儿MCA增快,而S/D、PI、RI值则降低。ICP组中胎儿MCA测值,Vm>35cm/s,S/D<4,PI<1·6,RI<0·6时引起围产儿预后不良者明显高于22cm/s<Vm<35cm/s,S/D>4,PI>1·6,RI>0·6者。②A、B、C、D四组中,C、D组致围产儿预后不良明显高于A、B两组,经χ2检验,差异有显著性(P<0·05)。A与B组,C与D组比较差异无显著性(P>0·05)。D组中围产儿预后不良病情更严重。结论用彩超监测胎儿MCA的血流动力学变化,可预测围产儿预后不良。当ICP孕妇血清胆汁酸升高同时伴有谷丙转氨酶或谷草转氨酶,总胆红素或间接胆红素升高,预示着ICP孕妇围产儿预后不良者更多,特别当出现胆酶分离现象时,预示围产儿病情更严重,应尽早结束妊娠。

Objective To inspect ICP fetal middle cerebral artery （MCA） blood flow hemodynamical change and to predict perinatal unfavourable prognosis by using Color Doppler Ultrasound.Methods The Mean velocity of fetal MCA （Vm）, the ratio of systolic to diastolic flow velocity （S/D）,the Pulsatile Index （PI） and the Resistance Index （RI） were measured by Color Doppler Ultrasound. And the patients with ICP were divided into 4 groups according to the difference of bile acid, glutamic - pyruvic transaminase （GFF） ,glutamic - oxal（o）acetic transaminase（GOT）, total bilirubin and indirect bilirubin. Results ①Vm of fetus in ICP pregnant women is higher than that of normal group,but S/D,PI, RI were decreased.②Perinatal Unfavourable prognosis in ICP groups were evidently higher than that of normal pregnant group.③In the group of ICP, the measuring value of fetal MCA with Vm 〉 35 cm/s, S/D 〈 4, PI 〈 1. 6, RI 〈 0.6 resulting in perinatal unfavourable prognosis were evidently higher than that with 22 cm/s 〈 Vm ≤ 35 cm/s, S/D 〉 4, PI 〉1. 6, RI 〉 0.6. Conclusion Measurement of the fetal MCA blood flow hemodynamical change by color Doppler ultrasound can predict perinatal unfavourable prognosis.