妊娠中晚期重度子痫前期妇女胎盘-胎儿的三维能量多普勒超声研究

Three-dimensional power Doppler ultrasound study of placenta-fetus in women with severe preeclampsia in middle and late pregnancy

目的分析处于妊娠中晚期且合并重度子痫前期妇女的胎盘胎儿三维能量多普勒(3D-PDI)超声检查情况。方法选取2017年5月至2019年1月在分宜县人民医院分娩的100例妊娠中晚期重度子痫前期孕妇作为研究组,选取同期在我院分娩的100例健康孕妇作为对照组。两组孕妇均行3D-PDI超声检查,比较孕妇子宫动脉和脐动脉血管收缩期/舒张期流速比值(S/D)、血流搏动指数(PI)、阻力指数(RI);并根据三维能量直方图计算两组孕妇胎盘组织的血流指数(FI)、血管指数(VI)和血流血管指数(VFI);比较两组孕妇胎儿主动脉峡部(AoI)的峡部血流指数(IFI)以及舒张期血流和心房收缩波(DV-a)出现消失或反向的例数。结果经检测,研究组孕妇子宫动脉的S/D、PI、RI指标分别为2.81±0.73、1.24±0.31、0.66±0.28,而对照组孕妇分别为1.94±0.56、0.89±0.27、0.51±0.20,差异均具有统计学意义(P<0.05);研究组孕妇脐动脉的S/D、PI、RI指标分别为3.18±0.64、1.42±0.76、0.83±0.21,对照组分别为2.68±0.51、0.98±0.21、0.62±0.38,差异均具有统计学意义(P<0.05);研究组孕妇的胎盘血流FI、VI、VFI分别为3.49±1.08、1.27±0.21、0.69±0.23,对照组分别为5.80±1.23、1.89±0.32、0.86±0.17,两组比较差异均具有统计学意义(P<0.05);研究组孕妇胎儿的平均IFI指数为0.13±0.94,明显低于对照组孕妇胎儿的1.38±0.12,差异具有统计学意义(P<0.05);研究组胎儿IFI分型为Ⅰ型的胎儿比例为61.0%,明显低于对照组的95.0%,差异具有统计学意义(P<0.05);研究组中胎儿舒张期血流和DV-a出现消失或反向的比例分别为42.0%和13.0%,明显高于对照组的16.0%和0,差异均具有统计学意义(P<0.05)。结论3D-PDI超声检测能够有效监测孕妇胎盘及胎儿的血流状况,使医务人员能准确判断孕妇的子痫先兆,因此,3D-PDI对于孕妇重度子痫前期具有很好的预测和诊断价值。

Objective To analyze three-dimensional power Doppler(3D-PDI)ultrasonography of placental fetus in women with advanced pre-eclampsia and in pre-eclampsia.Methods A total of 100 pre-eclampsia pregnant women,who were delivered to Fenyi County People's Hospital from May 2017 to January 2019,were selected as the study group.During the same time,100 healthy pregnant women who were delivered in the hospital were selected as the control group.3D-PDI ultrasound was performed on both groups of pregnant women.The systolic/diastolic flow ratio(S/D),blood flow index(PI),and resistance index(RI)of uterine artery and umbilical artery in pregnant women were observed.The blood flow index(FI),vascular index(VI)and blood flow vascular index(VFI)of the placenta tissues of the two groups of pregnant women were calculated according to the three-dimensional energy histogram.At the same time,the isthmic flow index(IFI)of the fetal aortic isthmus(AoI)of the two groups of pregnant women was collected and the number of cases in which diastolic blood flow and atrial contraction wave(DV-a)disappeared or reversed were collected.Results The S/D,PI,and RI indexes of the uterine artery in the study group were 2.81±0.73,1.24±0.31,and 0.66±0.28,respectively,versus corresponding 1.94±0.56,0.89±0.27,and 0.51±0.20 in the control group(all P<0.05).The S/D,PI,and RI indexes of the umbilical arteries of the pregnant women in the study group were 3.18±0.64,1.42±0.76,and 0.83±0.21,respectively,versus corresponding 2.68±0.51,0.98±0.21,and 0.62±0.38 in the control group(all P<0.05).The placental blood flow FI,VI,and VFI of the pregnant women in the study group were 3.49±1.08,1.27±0.21,and 0.69±0.23,respectively,versus corresponding 5.80±1.23,1.89±0.32,and 0.86±0.17 of the control group(all P<0.05).The average IFI index of the pregnant women in the study group was 0.13±0.94,which was significantly lower than 1.38±0.12 of the control group(P<0.05).From the IFI classification,the proportion of fetal IFI Ⅰ in the study group was 61.00%,which was significantly lower than 95.00%in the control group(P<0.05).From the diastolic blood flow and the disappearance or reversal of DV-a,the proportion of fetal diastolic blood flow and DV-a disappeared or reversed in the study group were 42.0%and 13.0%respectively versus corresponding 16.0%and 0 in the control group(all P<0.05).Conclusion 3D-PDI ultrasound detection can effectively monitor the blood flow status of pregnant women's placenta and fetus,and prompt the severe pre-eclampsia of pregnant women in the middle and late pregnancy,so that medical staff can accurately determine the eclampsia of pregnant women.Therefore,3D-PDI has a good predictive and diagnostic value for pregnant women with severe pre-eclampsia.