超声多普勒测定胎儿脐动脉血流的临床意义

Clinical Significance of Ultrasonic Measurement of Umbilical Artery Flow

目的:了解多种妊娠合并症时脐动脉血流的变化及与围产结局的关系。方法:对象为住院分娩的单胎孕晚期妇女共200例。于分娩前2天内应用超声测量脐动脉血流S/D值,并记录下有无妊娠合并症如妊高征(PIH)、早产、臀位等和脐带、胎盘、羊水性状及分娩方式、新生儿Apgar评分,比较不同分组间S/D值的差异。结果:脐动脉S/D与孕周和新生儿出生体重呈负相关,R=-0.180,r=-0.578(P<0.05和P<0.001)。中、重度妊高征患者S/D值高于正常对照组及轻度妊高征组(P <0.01)。脐带绕颈组S/D值升高,臀位、早产、胎盘异常、羊水过少或粪染组S/D值均高于对照组。顺产组及手术产组脐动脉S/D值无显著性差异(P>0.05),但因胎窘行手术者S/D值高于无胎窘者(P<0.001)。Apgar低评分组脐动脉S/D值高于正常评分组。结论;妊高征、脐带绕颈、胎盘异常、臀位、羊水过少等合并症均可导致脐带血流阻力增大,表现为脐动脉S/D值升高,胎儿营养障碍,影响生长发育,容易引起胎窘及新生儿窒息,特别是几个不利因素合并存在时.S/D升高更加明显。该值的增加预示胎儿宫内状况危险,应加强监护,适时终止妊娠以获得理想的围产结局。目的:了解多种妊娠合并症时脐动脉血流的变化及与围产结局的关系。方法:对象为住院分娩的单胎孕晚期妇女共200例。

Objective: To study the umbilical blood flow velocity (UmA S/D) change in various pregnancy complications and the relationship between the UmA S/D and the perinatal outcome. Methods: The ultrasonic measurement of the UmA S/D was made within 2 days before delivery in 200 singleton pregnant women. The information about pregnancy complication, umbilical cord, placenta, amnio fluid, delivery pattern and Apgar score was recorded. Results: The UmA S/D was reversely correlated with gestationsal age (r=-0.180,P<0.05) and with fetal birth weight (r=-0.578, P<0.001). The UmA S/D in moderate or severe PIH patients was higher than that in mild PIH patients or normal controls (P<0.01). The UmA S/D in patients with umbilical cord coiling, breech presentation, preterm labor, oligoamnios or placental abnormality was higher than that in controls. There was no difference between vaginal delivery group and surgery group, but the UmA S/D in patients underwent surgery because of fetal distress was higher than that of no fetal distress (P<0.001). The UmA S/D in low Apgar score group was higher than that in normal score group. Conclusion: Various pregnancy com-plications can lead to the increase of umbilical blood flow resistance. The increase of UmA S/D predicts a fetal risk. In order to obtain the best perinatal outcome, the fetal care should be intensified and the best delivery time and mode should be selected.