超声监测羊水过少胎儿主动脉峡部血流指数的临床价值

Clinical value of measuring aortic isthmus flow index in fetuses with distress and oligohydramnios by ultrasound

目的探讨超声监测主动脉峡部(AOI)血流频谱变化特征诊断羊水过少胎儿窘迫的价值。方法选取2019年3月至11月于河北北方学院附属第一医院行超声检查的羊水过少胎儿83例,将其分为窘迫组(64例)与无窘迫组(19例),另选取同期200例羊水量正常胎儿为对照组。获取3组胎儿AOI血流频谱,观察舒张期血流有无缺失或反向,测量收缩期速度时间积分,舒张期速度时间积分,计算主动脉峡部血流指数(IFI),并进行分型。采用方差分析比较3组间IFI的差异,组间两两比较采用LSD-t检验,采用χ2检验比较3组间IFI分型的差异。结果窘迫组胎儿IFI值低于对照组和无窘迫组(0.16±1.09 vs 1.21±0.05 vs 1.19±0.06),差异均有统计学意义(t=13.773、7.543,P均<0.05),无窘迫组胎儿IFI值与对照组比较,差异无统计学意义(P>0.05)。窘迫组胎儿AOI舒张期血流缺失或反向率高于对照组和无窘迫组(68.42%vs 1.56%vs 0),差异均具有统计学意义(χ2=89.822、55.710,P均<0.05),无窘迫组与对照组比较,差异无统计学意义(P>0.05)。无窘迫组与对照组胎儿IFI分型均为Ⅰ型,差异无统计学意义(P>0.05)。窘迫组胎儿IFI分型Ⅰ型8例,Ⅱ型7例,Ⅲ型4例,与对照组和无窘迫组比较,差异均有统计学意义(χ2=44.556、26.118,P均<0.05)。结论超声监测羊水过少胎儿AOI血流频谱可用于评价胎儿窘迫状况,提示临床医师及时采取有效干预措施。

Objective To evaluate the clinical value of ultrasound diagnosis of fetal distress with oligohydramnios by monitoring aortic isthmus(AOI)blood flow profile.Methods From March to November 2019,83 cases of oligohydramnios were examined by ultrasound at the First Affiliated Hospital of Hebei North University,and they were divided into either a distress group(64 cases)or a non-distress group(19 cases).Two hundred fetuses with normal amniotic fluid volume were selected as a control group.Fetal AOI blood flow profiles were obtained in the three groups to observe whether diastolic blood flow was absent or reversed.Fetal systolic and diastolic flow velocity-time integrals were measured to calculate and type isthmus flow index(IFI).Analysis of variance was used to compare the IFI differences among the three groups,the LSD-t test was used to compare the IFI differences between two groups,and the difference of IFI classification between the three groups was compared by theχ2 tests.Results The IFI in the distress group was lower than those in the control group and the non-distress group(0.16±1.09 vs 1.21±0.05 and 1.19±0.06,t=13.773 and 7.543,P<0.05 for both),but there was no significant difference between the non-distress group and the control group(P>0.05).The rate of the diastolic fetal AOI blood flow disappearance or reversal in the distress group was higher than those in the control group and the non-distress group(68.42%vs 1.56%and 0,χ2=89.822 and 55.710,P<0.05 for both),though there was no significant difference between the non-distress group and the control group(P>0.05).The types of IFI in the non-distress group and the control group were all type I,and the difference between them was not statistically significant(P>0.05).Compared with the control group and the non-distress group,the types of IFI in the distress group were type I(8 cases),type II(7 cases),and type III(4 cases);the differences were statistically significant(χ2=44.556 and 26.118,P<0.05 for both).Conclusion Monitoring blood flow profile of the fetal AOI can be used to evaluate fetal distress with oligohydramnios and guide clinicians to take effective intervention measures promptly.