胎儿脐动脉及大脑中动脉血流动力学指标对妊娠晚期胎儿宫内窘迫的预测分析

Predictive value of hemodynamic parameters of fetal umbilical artery and middle cerebral artery in intrauterine distress in late pregnancy

目的分析妊娠晚期宫内窘迫胎儿脐动脉(UA)及大脑中动脉(MCA)血流动力学指标的多普勒超声孕检资料,探讨妊娠晚期胎儿宫内窘迫的预测指标。方法选取妊娠晚期胎儿宫内窘迫孕妇52例,查看其胎儿宫内窘迫时与之前无胎儿宫内窘迫(以下称胎儿宫内窘迫前)的多普勒超声孕检资料,比较胎儿窘迫时及窘迫前MCA及UA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)等血流动力学指标,依据血流动力学检测指标统计学结果,判定妊娠晚期诊断胎儿宫内窘迫预测指标。结果胎儿宫内窘迫时脐动脉PI、S/D指数高于窘迫前(P<0.05),大脑中动脉PI指数低于窘迫前(P<0.05),MCA与UA的PI比值(PI_(MCA/UA))低于窘迫前(P<0.05)。当PI_(MCA/UA)以1.05作为界限值预测胎儿宫内窘迫时,其敏感度(88.97%)与特异度(82.87%)较高,阳性预测值(89.88%)与阴性预测值(95.13%)均高于单一血管PI指数。结论 MCA与UA的PI比值(PI_(MCA/UA))可作为预测胎儿宫内窘迫的独立因素,产前定期检查PI_(MCA/UA)可及时诊断胎儿宫内窘迫,依据病情给予相应治疗方案,可改善围生儿预后。

Objective To investigate the predictive values of hemodynamic parameters of fetal umbilical artery （UA） and middle cerebral artery （MCA） in fetal intrauterine distress in late pregnancy. Methods The data of Doppler ultrasound pregnancy during fetal intrauterine distress and before fetal intrauterine distress were examined. The peak systolic blood flow （PSV）, the ratio of systolic blood flow peak and the end-diastolic blood flow velocity （S/D）, pulsatility index （PI）, resistance index （RI） and other hemodynamic indexes of MCA and UA during fetal intrauterine distress and before fetal intrauterine distress were compared. The predictors of fetal distress in late pregnancy were predicted according to the statistical results of hemodynamic parameters. Results The indexes of PI and S/D of UA during fetal intrauterine distress were higher than those before fetal intrauterine distress （P 〈 0. 05） , the indexes of PI of MCA were lower than those before fetal distress （ P 〈 0. 05 ）, the ratio of MAC and UA （ PIMcA/UA ） was lower than that before fetal intrauterine distress （P 〈 0. 05 ）. Using PIMcA/UA = 1. 05 as the threshold value to predict fetal intrauterine distress, the sensitivity （88.97%） and specificity （82. 87% ） were higher, and the positive predictive value （89.88%） and negative predictive value （95.13%） were higher than those of single vessel PI index. Conclusions The ratio of MAC and UA （ PIMCA/UA ） may be an independent factor in predicting acute fetal intrauterine distress. Regular prenatal examination of PIMcA/UA can diagnose fetal distress in time and give the corresponding treatment plan according to the condition of the disease, which can improve the prognosis of perinatal fetus.