脐带缠绕胎儿肾动脉血流动力学状况预测胎儿窘迫的临床意义

Clinical significance of predicting fetal distress using renal artery hemodynamics in fetus with cord entrapment

目的观察脐带缠绕胎儿肾动脉血流动力学状况对预测胎儿窘迫的临床意义。方法选取2015年3月~2016年3月在我院进行产前检查和分娩的足月妊娠孕妇100例,产后证实脐带缠绕胎儿有93例,彩超测量临产前胎儿的MCA、RA、UA血流动力学状况,根据分娩结果分成正常组43例和胎窘组50例。结果正常组胎儿临产前RA的S/D值和PI值分别为(4.28±1.31)和(1.02±0.41),胎窘组胎儿临产前RA的S/D值和PI值分别为(5.83±2.57)和(1.86±0.38),胎窘组胎儿临产前RA的S/D值和PI值显著高于正常组,差异有统计学意义(S/D值P<0.05,PI值P<0.01);正常组胎儿临产前RA的RI值为(0.80±0.31),胎窘组胎儿临产前RA的RI值为(0.80±0.09),差异无显著性(P>0.05)。正常组胎儿临产前RA、MCA的S/D值和PI值分别为(1.24±0.53)和(1.22±0.45),胎窘组胎儿临产前RA、MCA的S/D值和PI值分别为(1.56±0.78)和(1.48±0.49),两组比较差异有统计学意义(P<0.05);正常组胎儿RA、MCA的RI值为(1.13±0.35),胎窘组胎儿RA、MCA的RI值为(1.12±0.21),差异无统计学意义(P>0.05)。正常组胎儿临产前UA与MCA的S/D值、PI值、RI值分别为(0.65±0.25)、(0.68±0.22)、(0.80±0.16),胎窘组胎儿临产前UA与MCA的S/D值、PI值、RI值分别为(0.68±0.23)、(0.67±0.23)、(0.81±0.15),两组比较差异均无统计学意义(P>0.05)。结论临产前彩超监测RA的S/D值和PI值(特别是S/D值)对预测脐带绕颈胎儿分娩时是否会发生胎儿窘迫有一定的临床诊断价值。

Objective To investigate the clinical significance of predicting fetal distress using renal artery hemodynam- ics in fetus with cord entrapment. Methods 100 pregnant women of full-term pregnancy who were examined and deliv- ered at the Affiliated Cangnan Hospital of Wenzhou Medical University from March 2015 to March 2016 were enrolled, 93 cases of umbilical cord entanglement in children after postpartum. The hemodynamics of MCA, RA and UA in pre- natal fetuses were measured by color doppler ultrasonography. Fetuses were divided into normal group with 43 cases and fetal distress group with 50 cases according to delivery outcomes. Results The S/D and PI of prenatal RA in fetuses of normal group were（4.28±1.31） and （1.02±0.41）. The S/D and PI of prenatal RA in fetuses of fetal distress group were （5.83±2.57） and （1.86±0.38）. The S/D and PI of prenatal RA in fetal distress group were statistical significantly higher than normal group（P〈0.05 for S/D, P〈0.01 for PI）. The RI of prenatal RA was（0.80±0.31） in normal group and （0.80± 0.09） in fetal distress group, while there was no significant difference（P〉0.05）. The S/D and PI of prenatal RA and MCA were（1.24±0.53） and （1.22-＋0.45） in normal fetuses and were （1.56±0.78） and（1.48±0.49） in fetal distress fetuses with significant difference（P〈0.05）. The RI of prenatal RA and MCA was （1.13±0.35） in normal fetuses and（1.12±0.21） in fetal distress fetuses, where there was no significant difference（P〉0.05）. The S/D, PI and RI of prenatal UA and MCA were（0.65±0.25）, （0.68±0.22） and （0.80±0.16） in normal fetuses and （0.68±0.23）, （0.67±0.23） and （0.81±0.15） in fetal distress fetuses with no significant diferenee （P〉0.05）. Conclusion S/D and PI values of RA （especially S/D） monitored by prenatal color doppler ultrasound have clinical diagnostic value on predicting incidence of fetal distress during labor in fetus with cord entrapment.