动静脉血流波形在重度子痫前期围产儿结局中的预测价值

Predictive value of arterial and venous blood flow waveforms in perinatal outcomes of severe preeclampsia

目的探讨胎儿动脉和静脉多普勒血流波形在晚孕重度子痫前期围产儿结局中的评估和预测价值。方法选取2015年3月-2016年3月该院重度子痫前期患者120例为研究对象,产前应用彩色多普勒超声检测胎儿脐动脉(UA)、大脑中动脉(MCA)、静脉导管(DV)的血流。随访和记录围产儿结局,按照其对应的动脉和静脉血流波形变化分为3组。第1组:MCA搏动指数(PI)>UA PI;第2组:MCA PI<UA PI,DV血流无异常;第3组:DV静脉峰值流速指数(PVIV)增高(>2S/D)。结果重度子痫前期围产儿出生孕周与围产儿结局密切相关,出生孕周越早越容易发生围产儿不良结局。第3组静脉血流波形异常,出生孕周、出生体质量和胎盘重量显著低于其他两组。围产儿死亡出现在第3组,其他不良结局发生率亦显著高于其他两组。UA舒张期血流缺失或反向13例,其中9例围产儿发生死亡,占69.2%;DV a波缺失或反向9例均发生围产儿死亡,占100%。结论胎儿动脉和静脉多普勒超声是一种评估和预测重度子痫前期围产儿结局的有效方法之一。胎龄和母体疾病严重程度是迫切分娩时考虑的重要因素。UA舒张期血流缺失或反向和静脉血流波形异常均为晚期血流波形变化,易产生围产儿不良结局,如胎儿已初步具备母体外生存能力应积极终止妊娠,以免进一步恶化,出现围产儿死亡。

Objective To explore the value of arterial and venous blood flow waveforms in prediction and prognosis of perinatal outcomes of severe preeclampsia. Methods A total of 120 patients with severe preeclampsia were selected from March 2015 to March 2016,color Doppler ultrasound was used to detect fetal umbilical artery( UA),middle cerebral artery( MCA),and ductus venosus( DV) before delivery. Perinatal outcomes were followed up and recorded,then the patients were divided into three groups according to changes of corresponding arterial and venous blood flow waveforms: the first group: pulsatility index( PI) of MCA > UA PI; the second group: MCA PI < UA PI,DV blood flow was normal; the third group: DV PVIV increased( > 2 SD). Results Gestational age of birth was closely related to perinatal outcomes of severe preeclampsia,adverse perinatal outcomes easily occurred in the patients with early gestational age of birth. Venous blood flow waveform was abnormal in the third group; gestational age of birth,birth weight,and placental weight in the third group were statistically significantly lower than those in the other two groups. Perinatal death occurred in the third group,the incidence rate of other adverse perinatal outcomes was statistically significantly higher than those in the other two groups. Blood flow loss or reversion of UA during di-astolic phase occurred in 13 patients, perinatal death occurred in 9patients,accounting for 69. 2%; all the 9 patients with blood flow loss or reversion of DV a wave died,accounting for 100%. Conclusion Fetal arterial and venous blood flow ultrasonography is an effective method in evaluating and predicting perinatal outcomes of severe preeclampsia. Fetal age and severity of the disease are important factors of urgent delivery.Blood flow loss or reversion of UA during diastolic phase and abnormal venous blood flow waveform are blood flow waveform changes during late phase,adverse perinatal outcomes occur easily,pregnancy should be terminated actively if the fetus has a primary survival ability to avoid further deterioration and perinatal death.