彩色多普勒超声在肝内胆汁淤积症致脐动脉血流异常对胎儿宫内缺氧监测的价值

The diagnosis role of abnormal umbilical artery flow velocity waveforms in detecting fetal anoxia in intrahepatic cholestasis of pregnancy

目的 探讨妊娠期肝内胆汁淤积症 (intrahepaticcholestasisofpregnancy ,ICP)患者胎儿脐动脉血流异常对胎儿宫内缺氧的彩色多普勒超声监测价值。方法 选择足月妊娠或近足月妊娠的ICP患者31例 ,正常足月妊娠 30例 ,于剖宫产当天彩色多普勒探测脐动脉血流 ,剖宫产时检测脐动脉血pH值及脐动脉胆汁酸水平。结果 ICP缺氧组脐动脉血流异常率高于ICP不缺氧组及正常妊娠组 (分别为 75 .0 % ,15 .8% ,6 .7% ,P <0 .0 5 ) ;ICP缺氧组脐动脉血流收缩期与舒张期流速比 (S/D)值高于ICP不缺氧组及正常妊娠组 (分别为 3.81± 0 .5 4,2 .2 8± 0 .32 ,2 .2 2± 0 .35 ,P <0 .0 5 ) ;ICP缺氧组胆汁酸水平高于ICP不缺氧组及正常妊娠组 (分别为 2 5 .12± 9.2 1,15 .6 6± 4.72 ,8.92± 4.32 ,P <0 .0 5 )。ICP组脐动脉血流S/D值与脐动脉pH值呈负相关 (r =-0 .74,P <0 .0 5 ) ,ICP组脐动脉血流S/D值与脐动脉胆汁酸水平呈正相关 (r =0 .76 ,P <0 .0 5 )。结论 ICP患者脐动脉血流异常与ICP胎儿宫内缺氧明显有关 ,可能因ICP胎盘血流灌注不足以及ICP时高浓度的胆汁酸致脐血管及胎盘绒毛表面血管收缩、胎儿缺氧所致 ,故脐动脉血流的检测对ICP胎儿宫内缺氧有很好的监测价值。

Objective To investigate the diagnosis role of abnormal umbilical artery (UmA) flow velocity waveform (FVWS) for fetal anoxia in intrahepatic cholestasis of pregnancy(ICP).Methods Color Doppler ultrasound was used to detect blood FVWS of UmA in 31 cases with ICP and 30 cases normal pregnancy before cesarean section.Results The abnormal UmA FVWS rate in the group of ICP with fetal anoxia was higher than that without fetal anoxia, and higher than that in normal pregnancy group ( 75.0 %, 15.8 %, 6.7 %,respectively, P < 0.05 ). The mean systolic maximum velocity/diastolic minimum velocity ratio(S/D) and the mean bile acid consentration in ICP with fetal anoxia was higher than those without fetal anoxia, and higher than those in normal pregnancy group ( 3.81 ± 0.54 , 2.28 ± 0.32 , 2.22 ± 0.35 ,respectively, P < 0.05 and 25.12 ± 9.21 , 15.66 ± 4.72 , 8.92 ± 4.32 ,respectively, P < 0.05 ). Conclusions Abnormal UmA FVWS is related with fetal anoxia in ICP. The reduction of blood flow associated with the vasoconstrictive effect of bile acid especially at the level of placenta and umbilical vessels in ICP leads to insufficient fetal infusion and oxygenation. The UmA FVWS may play an important role in diagnosis of fetal anoxia in ICP.