胎儿脐带绕颈的彩色多普勒血流检测与临床分析

Detection of blood flow of umbilical cord around the neck of fetus with color Doppler and its clinical implication

目的探讨应用彩色多普勒超声检测脐带绕颈胎儿脐动脉血流参数改变的临床意义,帮助临床选择正确的分娩方式,降低围产儿死亡率。方法以行产前(1周内)检查及分娩的足月单胎头位孕妇作为观测对象。检出脐带绕颈246例,分为脐带绕颈1周组、2周组和3周组,以60例无脐带绕颈者作为对照组,比较各组脐动脉阻力指数(RI)及收缩期最大血流速度与舒张末期最大血流速度比值(S/D)。另与843例无脐带绕颈者比较分娩方式及结果之间的差异。结果脐带绕颈1周组RI、S/D与对照组比较无显著性差异(P>0·05),脐带绕颈2、3周组RI、S/D明显高于对照组(P<0·01)。脐带绕颈组胎儿宫内窘迫率、胎儿剖宫产率及羊水过少的发生率明显高于无脐带绕颈组(P<0·01)。结论脐动脉血流RI、S/D值是判断脐带绕颈胎儿宫内缺氧的敏感可靠指标,对临床选择合理的分娩方式,减少围产儿并发症具有指导意义。

Objective To investigate the value of determining parameters of blood flow of the umbilical artery in fetus with umbilical cord around the neck （UCAN） by color Doppler ultrasonography, and to select the correct technique to deliver the fetus in order to reduce the perinatal mortality rate. Methods Full term pregnant women with singleton and cephalic presentation were examined during one week before childbirth. 246 fetuses examined with UCAN and proved to have umbilical cord around the neck were divided into three groups： UCAN with one loop group, UCAN with two loops group and UCAN with three loops group. 60 cases without UCAN served as control. Resistance Index （RI） and systolic/diastolic blood current （S/D） of umbilical artery were analyzed. The childbirth mode and the results were compared with 843 fetuses without UCAN. Results No significant difference in RI and S/D existed between the group of UCAN with one loop and the group without UCAN （P〉0.05）, while there was significant difference in RI and S/D between the group without UCAN and the groups of UCAN with two loops and with three loops （P〈0.01）. The rates of fetal intrauterine distress, cesarean section and the incidence of deficiency in anmiotic fluid were obviously higher in cases of UCAN than in those cases without UCAN （P〈0. 01）. Conclusion RI and S/D of umbilical artery flow with UCAN as detected by color Doppler ultrasonography maybe clinically useful in the judgment of fetal intrauterine hypoxia, and it is helpful in optimize the technique of delivery to reduce complication of the fetus in perinatal period.