胎儿宫内窘迫时彩色多普勒超声监测胎儿脐动脉血流的应用价值分析

目的观察胎儿宫内窘迫时胎儿脐动脉血流特点，探讨胎儿宫内窘迫诊断中彩色多普勒超声监测胎儿脐动脉血流的应用价值。方法选取2010年3月至2015年4月共168例超声诊断为胎儿宫内窘迫患者作为宫内窘迫组，同时选取同时期的150例正常孕妇作为对照组，比较观察两组孕妇脐动脉收缩末期（S）／脐动脉舒张末期（D）值、阻力指数（RI）、搏动指数（PI）及产程不同阶段的S／D值等指标。结果对照组孕妇脐动脉血流的S／D（2．48±0．51）、RI（0．48±0．12）、PI（0．86±0．21）值均明显低于宫内窘迫纽S／D（3．54±0．47）、RI（0．79±0．17）、PI（1．63±0．42）值，且差异具有统计学意义（P〈0．05）。宫内窘迫组中脐带绕颈两周的S／D值（2．81±0．26）与RI值（0．76±0．07）及脐带绕颈≥3周患者的（3．29±0．27）与RI值（0．79±0．11）与无脐带绕颈患者（2．02±0．21）、（0．50±0．04）比较差异均有统计学意义（P〈0．05），宫内窘迫组胎儿在临产前S／D值（2．76±0．34）与对照组（2．12±0．21）有明显差异（P〈0．05），另其在潜伏期、活跃期、第二产程的S／D值（3．42±0．42）、（3．98±0．53）、（4．67±0．76）呈上升趋势，与相同产程阶段的对照组（2．21±0．38）、（2．36±0．45）、（2．31±0．42）胎儿有明显差异（P〈0．05）。结论彩色多普勒超声监测胎儿脐血流可对胎儿宫内窘迫进行早期诊断，对临床诊断观察和选择合适的处理方式提供参考，对优生优育具有重要临床意义。

Objective To analyze the features of umbilical cord blood flow indexes in distress in uteruses, and to investigate the clinical value of color fetal umbilical cord blood flow in diagnosis of fetal distress in uterus. Methods Selected 168 patients who were fetal distress in uterus of section for outpatients of our hospital between March 2010 and April 2015 as fetal distress group, and then took 150 normal pregnant women as control group meanwhile.Compare the S/D, RI, PI, the S/D of different stages of birth process, and the Apgar score of neonates of the two groups. Results S/D （ 3.54 ± 0.47 ） , RI （ 0.79 ± 0.17 ） and PI （ 1.63 ± 0.42 ） values of fetuses under distress in uteruses were all significantly higher than those of the normal fetuses （ 2.48 ± 0.51 ） , （ 0.48 ± 0.12 ） , （ 0.86 ± 0.21 ） , and the differences were all statistically significant （ P〈0.05 ） . The S/D value （ 2.81 ± 0.26 ） and RI （ 0.76 ± 0.07 ） of two cycles cord around neck and three cycles around neck （ 3.29 ± 0.27 ） , （ 0.79 ± 0.11 ） in distress in uteruses group were much higher than without cord around neck （ 2.02 ± 0.21 ） , （ 0.50 ± 0.04 ） in distress in uteruses group, and had significant difference （ P〈0.05 ） . The differences in umbilical cord blood flow S/D values before birth the twogroups （ 2.76 ± 0.34 ） vs. （ 2.12 ± 0.21 ） had statistically significant （ P〈0.05 ） , in latent phase, active phase and the second stage of labor, the umbilical cord blood flow S/ D values （ 3.42 ± 0.42 ） , （ 3.98 ± 0.53 ） , （ 4.67 ± 0.76 ） of fetuses under distress in uteruses were gradually increased, while those normal fetuses （ 2.21 ± 0.38 ） , （ 2.36 ± 0.45 ） , （ 2.31 ± 0.42 ） changed insignificantly, and the differences between the two groups were statistically significant P （ P〈0.05 ） . Conclusions Color Doppler ultrasonic examination on fetal umbilical cord blood flow can effectively screen fetal distress in uterus, is beneficial to early diagnosis and therapy, can promote the rehabilitation of the sick babies, and consequently is worthy of clinical generalization and application.