静脉导管、脐静脉和脐动脉及大脑中动脉血流检测对子痫前期胎儿预后分析

The blood flow detection of ductus venosus,umbilical vein,umbilical artery and middle cerebral artery and prognosis analysis of preeclampsia fetus

目的：探讨子痫前期（PE）胎儿静脉导管（DV）、脐静脉（UV）和脐动脉（UA）及大脑中动脉（MCA）血流检测对围生儿预后分析。方法：应用彩色多普勒超声检测PE胎儿的DV、UV和UA及MCA血流参数,并与相应孕周正常妊娠胎儿的血流测值进行对照分析,研究分析其与胎儿不良结局的关系。结果：28-31＋6周及36周-分娩前,重度PE胎儿的DV、UV血流测值较正常、轻度PE胎儿升高（P〈0.05）,轻度PE与正常胎儿比较差异无统计学意义（P〉0.05）。32周-35＋6周,PE胎儿的DV血流参数测值PLI、PVIV、PIV及Qdv/Quv随着PE严重程度呈上升趋势（P〈0.05）。28周-分娩前,重度PE胎儿UA血流测值较正常、轻度PE胎儿升高（P〈0.05）,轻度PE胎儿UA血流测值RI、PI、S/D与正常胎儿比较差异无统计学意义（P〉0.05）,28-36周PE胎儿的MCA血流测值RI、PI、S/D与正常胎儿比较差异有统计学意义（P〈0.05）。PE胎儿DV、UV、UA血流测值与新生儿的出生体重、Apgar评分、脐动脉血氧饱和度、脐静脉p H值呈负相关。PE胎儿DV的PVIV、PIV,UV的Qdv/Quv,UA的PI、S/D和MCA的RI值与新生儿出生结局相关（P〈0.05）。结论：DV、UV血流频谱变化可反映PE胎儿宫内状况及预测出生不良结局,若结合UA、MCA血流频谱进行联合分析,将能更准确地评估胎儿的宫内状况。

Objective： To investigate the blood flow detection of ductus venosus（ DV）,umbilical vein（ UV）,umbilical artery（ UA） and middle cerebral artery（ MCA） in preeclampsia fetus（ PE） and perinatals prognosis analysis. Methods： Blood flow parameters of DV,UV,UA and MCA in preeclampsia fetus and normal fetus of corresponding gestational age were assessed and compared by color Doppler ultrasound instrument,and the relation between the blood flow parameters and poor perinatal outcomes were analyzed. Results： DV,UV values of 28 - 31weeks＋ 6and 36 weeks-before delivery severe preeclampsia fetus were significantly higher than that of normal and mild preeclampsia fetus（ P〈 0. 05）,and there were no significant differences between mild preeclampsia group and the control group（ P〈 0. 05）. DV blood flow parameters including preload index（ PLI） 、peak flow velocity（ PVIV） 、pulsed index（ PIV） and venous catheter blood flow / umbilical venous blood flow（ Qdv / Quv） in 32 - 35^＋ 6weeks preeclampsia fetus all tended to increase with the severity of preeclampsia（ P〈 0. 05）. UA values of 28 weeks -before delivery severe preeclampsia fetus were significantly higher than that of normal and mild preeclampsia fetus（ P〈 0. 05）. UA blood flow parameters including resistance index（ RI）,pulsatility index（ PI） and S / D ratio between mild preeclampsia group and the control group had no obvious difference（ P〈 0. 05）. The differences of MCA blood flow parameters including RI,PIand S / D between 28 weeks-36 weeks preeclampsia group and normal group were statistically significant（ P〈 0. 05）. There was a negative correlation between DV、UV、UA blood flow parameters in preeclampsia fetus and the birth weight of the newborns,Apgar scores、umbilical arterial blood oxygen saturation、umbilical venous PH. DV blood flow parameters including PVIV、PIV、Qdv / Quv,UA blood flow parameters including PI、S / D and MCA blood flow parameters RI had a certain relationship with birth outcomes（ P〈 0. 05）. Conclusion： Preeclampsia fetal DV、UV changes in blood flow spectrum as indicators for determining the fetal status can be used to predict the pregnancy outcomes. If we combine DV、UV and UA、MCA changes in blood flow spectrum,the fetal status will be assessed accurately.