晚孕期脐带绕颈胎儿静脉导管、大脑中动脉超声多普勒血流参数预测胎儿窘迫的临床价值

Clinical value of ultrasound Doppler blood flow parameter of ductus venosus and middle cerebral artery in predicting fetal distress in late pregnancy

目的应用彩色多普勒超声(CDFI)监测晚孕期脐带绕颈胎儿静脉导管(DV)、大脑中动脉(MCA)的血流参数变化,探讨其预测胎儿窘迫的价值。方法应用CDFI检测50例正常胎儿及50例脐带绕颈胎儿DV、MCA的血流参数并进行分析。结果正常组与脐带绕颈一周组比较无差异(P>0.05),与绕颈两周及以上组比较有非常显著差异(P<0.01),绕颈两周及以上组与绕颈一周组有显著差异(P<0.05)。脐带绕颈一周组胎儿QDV/UV、PLIDV与胎儿窘迫有低度正相关(r=0.271、r=0.215,P<0.05),RIMCA、S/DMCA与胎儿窘迫有低度负相关(r=-0.240、r=-0.316,P<0.05),绕颈两周及以上组胎儿QDV/UV、PLIDV与胎儿窘迫有中、高度正相关(r=0.726、r=0.532,P<0.05),RIMCA、S/DMCA与胎儿窘迫有中度负相关(r=-0.468、r=-0.545,P<0.05);QDV/UV、PLIDV、RIMCA、S/DMCA预测胎儿窘迫,灵敏度分别为90%、78%、74%、84%,特异度分别为58%、60%、71%、65%。结论应用CDFI监测DV及MCA多普勒血流参数对脐带绕颈胎儿预测胎儿窘迫有重要的临床应用价值。

Objective To monitor blood flood parameter changes of ductus venosus（DV） and middlecerebral artery （MCA） by color Doppler flow imaging （CDFI） in late pregnancy, to explore its value in predicting fetal distress. Methods Fifty normal fetuses and fifty fetuses with umbilical cord around the neck in late pregnancy were measured by CDFI for hemodynamics parameters of DV and MCA. Results There was no significant difference in hemodynamic parameters of DV and MCA between the normal group and the around （one round）the neck group（P 〉 O. 05 ）, but significant differences existed between the normal group and the around （two rounds ）the neck group （P 〈 O. O1 ）, and the one round group and the two rounds group（P〈0.05）. There was low positive correlation between Qov/uv, PLIov, and fetal distress （r = 0. 271, r=0.215,P 〈 0.05 ）, low negative correlation between RI S/D and fetal distress （r = -0. 240, r = -0.316,P 〈 O. 05）in the around （one round）the neck group;There was medium and high positive correlation between QDv/uv, PLIDV, and fetal distress （ r = 0. 726, r = 0. 532, P 〈 0. 05 ）, medium negative correlation between Rlmca,S/Dmcaa and fetal distress（ r = - 0. 468 ,r = - 0. 545, P 〈 0.05 ） in the around （two rounds）the neck group. The sensitivity of QDv/UV, PLiDv , RI S/D in predicting fetal hypoxia was 90% ,78%, 74%, 84%, and the specificity was 58%, 60%, 71%, 65%, respectively. Conclusions The measurement Doppler hemodynamic parameter of fetal DV and MCA by CDFI is of important values in predicting fetal distress.