晚孕期高危妊娠胎儿静脉导管与大脑中动脉搏动指数比值预测胎儿窘迫

Prediction of Fetal Hypoxia in Late Pregnancy by Measuring Ductus Venosus and Middle Cerebral Artery Pulsatility Index and the Pulsatility Index Ratio in High Risk Fetal

目的：探讨晚孕期高危妊娠胎儿静脉导管（DV）和大脑中动脉（MCA）博动指数（PI）及其比值（DV-PI/MCA-PI）预测胎儿宫内窘迫的应用价值。方法：超声测量95例36~42周高危妊娠胎儿（高危妊娠组）和100例36~41周正常妊娠胎儿（正常妊娠组）静脉导管（DV）和大脑中动脉（MCA）博动指数（PI）并计算其比值,用所获得的数据预测高危妊娠胎儿宫内窘迫的情况,结果与产后对照并进行诊断试验评价。结果：高危妊娠组与正常妊娠组DV-PI和MCA-PI值比较,差异均有统计学意义（P〈0.05）,DV-PI/MCA-PI比值比较差异有非常显著统计学意义（P〈0.01）;高危妊娠组胎儿出生后,69例发生新生儿窘迫,正常妊娠组胎儿出生后,6例发生新生儿窘迫,若以DV-PI〉0.6、MCA-PI〈1.1、DV-PI/MCA-PI〉0.5预测高危组胎儿宫内窘迫,其DV-PI/MCA-PI比值分别为78%、59%、82%、71%、91%、90%。结论：DV-PI/MCA-PI比值可用于预测高危妊娠胎儿宫内缺氧,并且优于单独使用DV-PI、MCA-PI,可协助临床尽早发现胎儿宫内缺氧以改善围生儿不良妊娠结局。

Objective：To investigate the value of ductus venosus（DV） and middle cerebral artery（MCA） pulsatility index（PI） and DV-PI/MCA-PI in predicting fetal hypoxia in high-risk in late pregnancy.Method：95 fetuses between 36 and 42 weeks in high-risk（high-risk pregnancy group） and 100 normal fetuses between 36 and 41 weeks（normal pregnancy group） were measured for DV and MCA pulsatility index（PI） by means of color Doppler ultrasonography,and the pulsatility index（PI） ratio was calculated.Fetuses in high-risk were estimated according to the measured normograms for the presence of fetal hypoxia,and the results were evaluated by diagnostic test.Result：Significant differences were found in DV and MCA pulsatility index and pulsatility index ratio betweentwo groups（P〈0.01）.The sensitivity and specificity of DV and MCA pulsatility index and pulsatility index ratio in predicting fetal hypoxia in high risk fetal were respectively 78%,59%,82%,71%,91% and 90%.Conclusion：DV and MCA pulsatility index ratio is a better indicator than its pulsatility index in predicting fetal hypoxia of fetuses in high-risk pregnancy,and may help in early detection of fetal hypoxia for a diagnosis before fetal distress.