胎儿脐动脉及大脑中动脉血流动力学指标在检测妊娠晚期胎儿宫内窘迫中的应用

Application of the hemodynamic parameters of fetal umbilical artery and middle cerebralarteryin predicting fetal distress in late pregnancy

目的 探讨联合胎儿脐动脉（UA）及大脑中动脉（MCA）血流动力学指标在预测妊娠晚期胎儿宫内窘迫的应用价值.方法 采用多普勒超声检测84例正常组和56例窘迫组的UA、MCA的收缩期血流峰值（PSV）、收缩期血流峰值与舒张末期血流速度比值（S/D）、搏动指数（PI）及阻力指数（RI）.结果 窘迫组UA的PI、S/D指数高于正常组（P〈0.05,P〈0.01）,MCA的PI指数低于正常组（P〈0.05）,MCA与UA的PI比值（PIMCA/UA）低于正常组（P〈0.01）.PIMCA、PIUA、PIMCA/UA分别以1.0、0.9、1.05作为界限值预测胎儿宫内窘迫时,敏感度分别为76.12%、67.59%、89.84%,特异度分别为80.56%、75.79%、83.47%,阴性预测值分别为79.68%、75.14%、96.47%.结论 MCA与UA的PIMCA/UA指标可能成为预测胎儿宫内窘迫的独立因素,可为临床提供治疗及预后依据.

Objective To study the diagnostic value of the hemodynamic parameters of fetal umbilical artery （UA） and middle cerebralartery （MCA） in predicting fetal distress in late pregnancy.Methods Color Doppler was used to examine fetal UA and MCA hemodynamic parameters in two groups： normal pregnancy （84 cases） and pregnancy with fetal distress （56 cases）, the peak systolic （PSV）, peak systolic and end diastolic velocity ratio（S/D）, resistance index （RI） and pulsatility index （PI） were detected.Results The PI and S/D of fetal UA in the patient group were higher than those in the normal group （P〈0.05, P〈0.01）, PI of fetal MCA were lower than those in the normal group （P〈0.05）, and the PIMCA/UA of the patient group were lower than those of the normal group （P〈0.01）.PIMCA=1.0, PIUA=0.9, PIMCA/UA=1.05 were used as the threshold value to predict fetal distress, the sensitivity were 76.12%, 67.59% and 89.84% respectively, and the specificity were 80.56%, 75.79% and 83.47%, the negative predictive value were 79.68%, 75.14% and 96.47%.Conclusions The PIMCA/UA value between MCA and UA could be the independent factor in predicting of acute fetal distress, and can provide references for treatment and prognostic in clinic.