脐动脉血流速度检测及胎心监护对子宫内缺氧的预测价值

Comparison of Doppler examination and non-stress test in the prediction of intrauterine fetal hypoxia

目的 比较多普勒超声脐动脉血流速度检测和胎心监护———无负荷试验 (NST)对胎儿宫内缺氧的预测价值。方法 检测 4 32 6例正常妊娠妇女的脐动脉收缩期最大血流速度 (S)与舒张末期血流速度 (D)的比值 (S/D)、脐动脉血流搏动指数 (PI)、脐动脉血流阻力指数 (RI)、快速血流量比(FVR) ,建立妊娠晚期各孕周相应的正常值。同时对 2 873例正常晚期妊娠妇女 ,进行多普勒超声脐动脉血流速度检测和NST ,追踪检测后 1周内出生的新生儿情况 ,并与检测结果对照。结果 (1)正常妊娠妇女S/D、PI、RI值随孕周的增加而逐渐下降 ,FVR值则变化不大。 (2 )脐动脉血流S/D、PI、RI、FVR值和NST分别异常者 ,新生儿出生时表现有宫内缺氧情况者分别为 6 2 0 %、6 0 7%、6 3 3%、2 7 0 %和 75 7% ,而脐动脉血流S/D、PI、RI、FVR值和NST正常者 ,新生儿出生时表现有宫内缺氧情况者分别为 12 8%、13 9%、13 0 %、15 7%和 7 5 % ,两者比较差异有极显著性 (P <0 0 1)。 (3)多因素回归分析显示 ,RI和NST两个变量与胎儿宫内缺氧关系密切 ,差异有显著性 (P <0 0 5 )。结论 NST和RI值在正常妊娠妇女中 ,预测宫内缺氧的临床价值较好 。

Objective To assess the predictive value of intrauterine fetal hypoxia by Doppler examination and non stress test(NST) Methods The normal value of the peak systolic and diastolic ratio(S/D), pulse index(PI), resistance index(RI), fast volume ratio(FVR)of different gestational age was created according to 4 326 normal pregnancy. S/D, PI, RI, FVR and NST was performed for 2 873 normal pregnancy at the last trimester.Fetal outcomes were recorded within 7 days of birth Results (1)S/D, PI, and RI decreased with the gestational age advancing,but FVR didn't.When S/D, PI, RI, FVR or NST appeared abnormal,the ratio of intrauterine fetal hypoxia was 62.0%,60.7%,63.3%,27.0% and 75 7% respectively, as these normal,the ratio of intrauterine fetal hypoxia was 12 8%,13 9%,13 0%, 15 7%,7 5% respectively There was significant difference ( P <0 01) (2)Logistic regression showed that the predictive value of RI and NST to intrauterine fetal hypoxia was significant( P <0 05). Conclusions The predictive value of NST and RI to intrauterine fetal hypoxia was stronger than other parameters. Multi parameter may predict more accurately than any single index for intrauterine fetal hypoxia.