超声血流频谱参数联合BPS评分诊断胎儿宫内窘迫的价值研究

Study on the value of ultrasound blood flow spectrum parameters combined with BPS score in the diagnosis of fetal distress

目的探讨超声血流频谱参数与BPS评分诊断胎儿宫内窘迫的价值。方法选择2016年4月—2019年4月本院妇产科收治的50例胎儿宫内窘迫孕妇作为观察组,另选同期于本院进行产检的50例正常孕妇为对照组。观察组(治疗前)及对照组入院后均接受BPS评估分与超声血流频谱参数评估,检查胎儿大脑中动脉血流阻力(MCA)、脐动脉(UA)及静脉导管(DV),其中MCA、UA均包含搏动指数(PI)、阻力指数(RI)收缩和舒张期流速比值(S/D),DV包含静脉搏动指数(PIV)、静脉峰值流动指数(PVIV);并以受试者工作曲线(ROC)曲线分析孕妇BPS及胎儿血流参数诊断胎儿宫内窘迫的价值。结果观察组孕妇BPS评分低于对照组,差异有统计学意义(P<0.05);观察组UA^(PI)、UA_(RI)、UA_(S/D)、DV_(PIV)和DV_(PVIV)参数均高于对照组,MCA_(PI)、MCA_(RI)和MCA_(S/D)参数均低于对照组,差异均有统计学意义(P<0.05)。经ROC分析,BPS、MCA_(PI)、MCA_(RI)、MCA_(S/D)、UA^(PI)、UA_(RI)、UA_(S/D)、DV_(PIV)、DV_(PVIV)及联合诊断胎儿宫内窘迫的曲线下面积分别为0.887、0.703、0.834、0.753、0.826、0.701、0.747、0.841、0.763及0.903,相比较之下联合诊断能够获得更高的曲线下面积,且差异均有统计学意义(P<0.05)。结论超声血流频谱参数联合BPS评分的方式对胎儿宫内窘迫进行诊断有利于减少漏诊、误诊,以尽早采取积极措施。

Objective To study the value of ultrasound blood flow spectrum parameters and BPS score in the diagnosis of fetal distress.Methods From April 2016 to April 2019,50 cases of pregnant women with fetal distress those be admitted to our hospital were selected as the observation group,and 50 cases of normal pregnant women were selected as the control group.Both the observation group(before treatment)and the control group received BPS scoring and ultrasound blood flow spectrum parameters evaluationafter admission.Fetal middle cerebral artery blood flow resistance(MCA),umbilical artery(UA)and venous catheter(DV)were examined.MCA and UA included pulsatility index(PI),resistance index(RI),systolic and diastolic velocity ratio(S/D),DV includes venous pulsatility index(PIV),peak venous flow Dynamic index(PVIV);ROC curve was used to analyze the value of BPS and fetal blood flow parameters in the diagnosis of fetal distress.Results The BPS score of the observation group was significantly lower than that of the control group,P<0.05;the parameters of UA^(PI),UA_(RI),UA_(S/D),DV_(PIV) and DV_(PVIV) in the observation group were significantly higher than those in the control group,while the parameters of MCA_(PI),MCA_(RI) and MCA_(S/D) in the observation group were significantly lower than those in the control group,all P<0.05.ROC analysis showed that the area under the curve of BPS,MCA_(PI),MCA_(RI),MCA_(S/D),UA^(PI),UA_(RI),UA_(S/D),DV_(PIV),DV_(PVIV) and combined diagnosis of fetal distress were 0.887,0.703,0.834,0.753,0.826,0.701,0.747,0.841,0.763,0.903,respectively.Compared with single diagnosis,the combined diagnosis could achieve higherarea under the curve,and all P<0.05.Conclusions Ultrasound blood flow spectrum parameters combined with BPS score is helpful to reduce missed diagnosis and misdiagnosis,helps to take positive measures as soon as possible.