脐绕颈胎儿临产前三条动脉血流动力学参数的联合检测对胎儿窘迫发生的预测价值

Predictive Value of Fetal Distress by combined Detection of Hemodynamic Parameters of three arteries before and after Fetal Neck Bypass

目的:分析检测脐带绕颈胎儿临产前主要动脉血流动力学参数预测胎儿窘迫发生的临床价值,为临床选择合适的分娩时机及分娩方式提供超声诊断依据。方法:回顾性研究并收集住院待产的206例符合研究要求产妇的临床资料,根据胎儿窘迫具体发生情况分为正常组(159例)和窘迫组(47例)。两组对象胎儿临产前肾动脉(RA)、大脑中动脉(MCA)、脐动脉动脉(UA)血流动力学参数的差异,并将胎儿窘迫发生情况与各血流动力学参数拟合回归方程。结果:两组脐带绕颈胎儿临产前血流动力学参数的比较,其中肾动脉的S/DRA(t=6.017,P=0.000)、PIRA(t=3.950,P=0.000)、RIRA(t=2.146,P=0.033)的差异均有统计学意义;大脑中动脉的S/DMCA(t=2.041,P=0.042)、PIMCA(t=3.656,P=0.000)、RIMCA(t=2.509,P=0.012)的差异均有统计学意义;脐动脉的S/DUA(t=3.601,P=0.000)、PIUA(t=2.047,P=0.041)的差异均有统计学意义;多因素分析,影响脐带绕颈胎儿窘迫发生情况的9个动脉血流动力学参数均进入回归方程,影响大小(偏回归系数Exp)依次为:S/DMCA(9.30)、S/DRA(6.49)、PIUA(4.95)、PIMCA(4.76)、S/DUA(3.90)、PIRA(3.46)、RIRA(2.94)、RIUA(2.27)、S/DMCA(1.55)。结论:不同窘迫发生情况的脐带绕颈胎儿RA、MCA和UA血流参数的差异明显,应用彩色多普勒监测RA、MCA、UA具体参数。

Objective： To analyze the hemodynamic parameters of the main artery before fetal labor around the umbilical cord,predict the clinical value of fetal distress,and provide the basis for the diagnosis of the appropriate timing and mode of delivery. Methods： The clinical data of maternal fetal distress of 206 patients were collected and retrospective studied. According to the specific situation,all the patients were divided into normal group（ 159 cases） and hypoxia group（ 47 cases）. The fetal birth renal artery（ RA）,middle cerebral artery（ MCA） and umbilical artery（ UA） differences in hemodynamic parameters of the two groups were contrasted,and the incidence of fetal distress and the blood flow dynamics parameters of regression equation were fitted. Results： The difference of S/DRA,PIRA and RIRA between the two groups was statistically significant（ P〈0.05）; the middle cerebral artery S/DMCA,PIMCA（ P〈0.05）. There were statistically significant differences in the levels of S/DUA and PIUA in umbilical artery（ P〈0.05）. Multivariate analysis of nine arterial hemodynamics parameters affecting the incidence of fetal distress in the umbilical cord entered the regression equation. The influence size（ Exp） was S/DMCA（ 9.30） 、S/DRA（ 6.49） 、PIUA（ 4.95） 、PIMCA（ 4.76） 、S/DUA（ 3.90） 、PIRA（ 3. 46） 、RIRA（ 2. 94） 、RIUA（ 2. 27） 、S/DMCA（ 1. 55）. Conclusions： There are significant differences in RA,MCA and UA blood flow parameters of umbilical cord around rabbits with different distress,and the use of color Doppler to monitor the specific parameters of RA,MCA and UA,and the establishment of multivariate regression model is important for predicting the occurrence of fetal distress Value.