联合应用三维能量多普勒超声与脐动脉收缩期峰值/舒张末期血流速度评价正常中晚期妊娠胎盘血流灌注的价值

Value of three-dimensional power Doppler ultrasound combined with the ratio of the systolic peak value and the end-diastolic velocity of blood flow in evaluating placental blood perfusion in normal middle-late pregnancy

目的:探讨联合应用三维能量多普勒超声技术与脐动脉收缩期峰值/舒张末期血流速度(S/D)值评价胎盘血流灌注的价值。方法:对180例正常中晚期妊娠胎盘血流灌注进行二维、三维能量多普勒超声成像的对比,并将胎盘的三维能量多普勒指数:血管化指数(VI),血流指数(FI),血管化血流指数(VFI)与S/D值作相关分析。结果:对于胎盘血流灌注的成像,三维比二维能量多普勒超声能显示更丰富、更连续的血流信号。在显示率方面,对初级分支二维与三维能量多普勒差别无统计学意义(P>0.05);但对于次级和三级绒毛干血管,三维能量多普勒超声明显优于二维,差别均有统计学意义(均P<0.01)。胎盘的三维能量多普勒指数与脐动脉S/D值呈负相关。以S/D为自变量,三维能量多普勒指数为因变量的直线回归公式为:VI=-5.341×S/D+27.207,r=-0.483;FI=-2.005×S/D+57.663,r=-0.205;VFI=-2.972×S/D+14.771,r=-0.479;以上均为P<0.01。结论:三维能量多普勒超声是一项观察胎盘血流灌注非常实用的方法,联合应用三维能量多普勒指数与脐动脉S/D值可为临床早期、准确评价胎盘功能提供参考,并为高危妊娠的鉴别诊断提供客观依据。

Objective： To explore the value of three - dimensional power Doppler ultrasound combined with the ratio of systolic peak value and the end - diastolic velocity of blood flow （ S/D value） in evaluating placental blood perfusion. Methods： Two - dimensional power Doppler ultrasound and three - dimensional power Doppler ultrasound were used respectively to observe placental blood flow perfusion of 180 normal middle -late pregnant women, then the results were compared, placental three -dimensional power Doppler indexes were ana- lyzed, including vascularization index （VI） , flow index （FI） and vascularization flow index （VFI）, their correlations with S/D ratio were analyzed. Results： Three - dimensional power Doppler ultrasound had more abundant and continuous blood flow signals compared with two - dimensional power Doppler ultrasound. There was no statistically significant difference in show rate of primary branches between two - dimensional power Doppler ultrasound and three - dimensional power Doppler ultrasound （ P 〉 0. 05 ）, but the show rates of secondary and tertiary villi dry blood vessels of three - dimensional power Doppler ultrasound were statistically significantly higher than those of two - dimen- sional power Doppler ultrasound （P 〈 0. O1 ） . Placental three - dimensional power Doppler indexes were negatively correlated with S/D rati- o. Taking S/D ratio as the independent variable, the linear regression equations for VI, FI and VFI were VI = - 5. 341 x S/D ＋ 27. 207, r = -0.483; FI= -2.005 xS/D＋57.663, r= -0.205; VFI= -2.972 xS/D ＋14.771, r= -0.4799 （P〈0. 01） . Conclusion： Three - dimensional power Doppler ultrasound is a very practical method to observe placental blood flow perfusion. Three - dimensional pow- er Doppler indexes combined with umbilical artery S/D ratio can provide reference for early and accurate evaluation of placental function and an objective basis for differential diagnosis of high risk pregnancy.