产前超声检查顺序对脐动脉和大脑中动脉血流动力学的影响

Impact of Prenatal Ultrasonographic Sequence on Hemodynamics of Fetal Umbilical and Middle Cerebral Artery

目的研究分析产前超声检查顺序对脐动脉和大脑动脉血流的动力学影响。方法对来自我院的产检的50例使用彩色多普勒超声对胎儿的脐动脉和大脑中动脉的足额流动力学进行检测,比较出产前系统超声检查的前后的血流动力学变化。结果系统超声检查后的大脑中动脉的阻力指数(RI)、波动指数(PI)都有明显的下降[PI(1.71±0.21)VS(1.60±025),t=3.396,P<0.001;RI(0.80±0.05)VS(0.76±0.05),t=3.498,P<0.001],在舒张的末期血流速度要明显的升高[EDV(7.71±3.79)VS(8.89±5.17),t=2.19,P<0.05];MCA出现舒张期的血流缺失的概率要明显增多(χ2=4.51,P<0.05)。对其进行产前的检查后脐动脉的波动指数出现明显的下降[PI(1.02±0.24)VS(0.95±0.21),t=2.02,P<0.05],但大脑中动脉其他的血流动力学和血流的频谱形态没有明显的改变。结论在产前使用系统超声检查可能会对胎儿的脐动脉和大脑中动脉的血流动力学产生一定的影响,所以应该先对胎儿进行血流动力学的超声检测之后在进行其他的超声检查。

Objective To investigate the impact of prenatal ultrasonographic sequence on hemodynamics of fetalumbilical and middle cerebral artery. Methods Pulsed Doppler was used to measure blood flow velocities in the umbilical （UmA） and middlecerebral arteries （MCA） in fetuses from 22 to 39 weeksgestational age referred for fetal echocardiography and their hemodynamics parameters were compared before and after prenatal standard ultrasonography.Results After prenatal standard ultrasonography, the pulsatility index （PI） and resistance index （R1） of MCA descend obviously [PI （1.71±0.21） VS （1.60±025） , t=-3,396, P〈0.001; RI （0.80±0.05） VS （0.76±0.05） , t=3.498, P〈0.001] but the end diastolic velocity （EDV） of MCA increases obviously[EDV： （7.71±3.79） VS （8.89±5.17） , t=2.19, P〈0.05]; The probability of the absent diastolic blood flow in MCA increases obviously after prena-tal standard ultrasonography （x2=4.51, P〈0.05） . The PI of UreA descends obviously [PI： （1.02±0.24） VS （0.95±0.21） , t=2.02, P〈0.05], But there are no obvious changes in other hemodynamics parameters ,and the form of the flow spectrum of UmA. Conclusion Prenatal uhrasonographic sequence could impact upon fetal hemodynamics of UreA and MCA. This result suggests that fetal Doppler blood flow measurement should be prior to prenatal standard ultrasonography.