超微血流成像序贯化评估孕期胎盘绒毛血流的改变

Sequential assessment of placental villus blood flow in different pregnancy by superb microvascular imaging

目的探讨超微血流成像(SMI)技术评估不同孕期胎盘绒毛血流的价值。方法2019年1-6月于北京妇产医院早孕期建档的单胎妊娠孕妇中随机抽取50例,分别于早、中、晚孕期进行常规超声检查时应用SMI技术监测胎盘终末绒毛血流,记录是否可显示胎盘脐带插入点处、胎盘边缘处的胎盘绒毛血流,采集相应的动脉血流频谱并记录舒张期流速比(S/D)、搏动指数(PI)、阻力指数(RI)和收缩期峰值流速(PSV)。绒毛动脉血流频谱测量率与胎盘位置、胎儿体位、所处孕期的相关性采用Spearman相关分析;不同孕期间胎盘绒毛血流的显示率、血流频谱的测量率的比较采用卡方检验。两位超声医师间检查结果的一致性分析采用Kappa检验。结果最终完成检查的孕妇为30例。SMI胎盘绒毛血流的显示率为98.9%(89/90)。绒毛动脉血流频谱测量率与胎盘位置、胎儿体位无相关性(P>0.05),与所处孕期有相关性(rs=0.478,P<0.05)。各个孕期胎盘脐带插入点处、胎盘边缘处绒毛血流的显示率差异无统计学意义(P>0.05),血流频谱的测量率差异有统计学意义(P<0.05)且早孕期测量率(33.3%/3.3%)低于中孕期测量率(70.0%/50.0%)和晚孕期测量率(56.6%/60.0%)。两位超声医师间检查结果的一致性良好(Kappa=0.55~0.92,P<0.05)。结论SMI技术可以显示各孕期胎盘绒毛动脉血流,并可进行血流频谱测量。孕期对于测量结果有影响,中-晚孕期的绒毛动脉血流频谱较早孕期更易测量。胎儿体位、胎盘位置均不影响绒毛血流测量。

Objective To evaluate the placental villus blood flow in different pregnancy using superb microvascular imaging(SMI).Methods Fifty single pregnant women were randomly selected from early pregnancy pregnant women with outpatient examinations from January 2019 to June 2019.The SMI technique was used to monitor the villus blood flow of the placenta during routine ultrasound examination in early,middle and late pregnancy.The blood flow of the placental villus at the insertion point of the placenta umbilical cord and the edge of the placenta was explored,and the corresponding arterial blood flow spectrum was collected,and the values of systolic/diastolic velocity ratio(S/D),pulsatility index(PI),resistance index(RI)and peak systolic velocity(PSV)were recorded.The correlation between the measurement rate of villus blood flow spectrum and the placenta position,fetal position,and pregnancy period were analyzed by Spearman correlation.Chi-square test was used compare the difference of the display rates of placental villus blood flow and the measurement rates of blood flow spectrum during different pregnancy periods.The consistency analysis of the results between the two inspectors was performed using Kappa test.Results Finally,30 pregnant women were enrolled.SMI showed 98.9%(89/90)of placental villus blood flow.The consistency of the examination results between the two examiners was good.The measurement rate of villus artery blood flow spectrum was not correlated with the placenta and fetal position(P>0.05),but correlated with defferent trimesters(rs=0.478,P<0.05).There was no difference in the display rate of villus blood flow at the insertion point of the placenta umbilical cord and at the edge of the placenta in each trimester(P>0.05).The measurement rate of blood flow spectrum was statistically different(P<0.05).And the measurement rate of early pregnancy(33.3%/3.3%)was lower than the middle(70.0%/50.0%)and late pregnancy(56.6%/60.0%).The consistency of the examiners results between the two examiner is good(Kappa=0.55-0.92,P<0.05).Conclusions SMI can display the blood flow of placental villus in different stages of pregnancy and can measured blood flow accordingly.The different pregnancy stages affect the measurement results.Placental villus blood flow measurement in the middle and late pregnancy is easier to measure than in the early pregnancy.The fetal position and placental position do not affect blood flow measurement.