子痫前期患者胎盘血管铸型研究

A Study on the Placental Vascular Casting of Pre-eclampsia Pregnant Women

目的通过对子痫前期（PE）胎盘血管的结构铸型,探讨其血管分布结构。方法选择2007年10月—2010年10月在济南军区总医院妇产科住院分娩的胎盘88例,其中正常妊娠胎盘40例,PE胎盘40例,特殊胎盘8例。采用改良环氧树脂血管铸型方法铸型,采用沉水法测量胎盘血管床容积,计算末梢动静脉比值,观察胎盘血管铸型特点。结果正常妊娠胎盘血管可视分支由粗至细分为5-7级,末梢血管网络分支丰富,终于血窦;重度PE胎盘较正常妊娠胎盘脐静脉分支明显稀少。重度PE胎盘血管系统容量、脐静脉分级数小于正常妊娠胎盘,而末梢动静脉比值高于正常妊娠胎盘,且1-3级脐静脉内径显著小于正常妊娠胎盘同级血管,2或3级脐动脉内径小于正常妊娠胎盘同级血管（P〈0.05,P〈0.01）。结论胎盘血管铸型可直观了解胎盘血管系统的结构。重度PE胎盘血管床明显减小、3级血管分支直径减小和末梢动静脉分支比值上升,可能是导致其胎盘功能不足的器质性原因。

Objective To investigate vascular distribution and structure by analyzing placental vascular casting of pre-eclampsia（ PE） pregnant women. Methods A total of 88 pregnant women admitted during October 2007 and October 2010 were recruited in this study,including 40 normal pregnant women,40 PE pregnant women and 8 pregnant women with special placentas. An improved epoxy resin vascular casting technique was used. Placental vascular bed volume was measured using water displacement method. Peripheral artery-to-vein ratios were calculated,and placental vascular casting characteristics were observed. Results In normal pregnant women,the placental veins were branched into5-7 branches from large to small,and distal and rich vessel branches ended the blood sinusoid; numbers of venous tributary in placentas of pregnant women with severe PE were obviously decreased compared with those of normal pregnant women. The values of placental volumes of blood vascular system and classification of umbilical veins of pregnant women with severe PE were less than those of normal pregnant women,while the peripheral artery-to-vein ratio of pregnant women with severe PE was higher than that of normal pregnant women. The grade 1-3 internal diameters of umbilical veins were significantly small than those of same grades of normal pregnant women,and the grade 2 or 3 internal diameters of umbilical arteries of pregnant women with severe PE were significantly small than those of same grades of normal pregnant women（ P〈0. 05,P〈0. 01）. Conclusion The placental vascular casting may help to directly study the placental veins structures of pregnant women. The decreased placental vascular bed volume,small diameter of grade 3 vascular branch and increased peripheral artery-to-vein ratio of pregnant women with severe PE may be the cause of placenta insufficiency.