大脑中动脉及脐动脉S/D、NST预测胎儿宫内窘迫的临床价值

Diagnostic value of S/D of middle cerebral artery and umbilical artery,no stimulation of fetal heart rate monitoring in predicting fetal distress

目的探究大脑中动脉(MCA)、脐动脉(UA)收缩期与舒张期流速比值(S/D)、无刺激胎心监护(NST对胎儿宫内窘迫的预测价值。方法选择2020年1月至2021年4月在惠东县人民医院产检的200例孕妇作为研究对象,根据胎儿宫内窘迫的诊断标准将所有产妇分为宫内窘迫组73例和非宫内窘迫组127例,两组孕妇均在产前进行MCA、UA血流检测和NST监测。比较两组孕妇的MCA、UA的S/D比值和NST监测结果。比较不同MCA、UA的S/D比值、不同NST监测结果孕妇的Apgar评分以及宫内窘迫发生率。比较MCA S/D值、UA S/D值、NST监测单项以及三者联合诊断胎儿宫内窘迫的灵敏度、特异度和准确度。结果宫内窘迫组孕妇的MCA S/D值为2.87±0.61,明显低于非宫内窘迫组的3.81±0.79,UA S/D值为3.46±0.63,明显高于非宫内窘迫组的2.74±0.55,差异均有统计学意义(P<0.05);NST监测结果显示,宫内窘迫组孕妇中无反应型的比例为61.64%,明显高于非宫内窘迫组的18.90%,差异有统计学意义(P<0.05);MCA S/D值<3孕妇的新生儿Apgar评分为(6.58±1.33)分,明显低于MCA S/D值≥3孕妇的(8.08±1.57)分,MCA S/D值<3孕妇的宫内窘迫发生率为65.33%,明显高于MCA S/D值≥3孕妇的19.20%,差异均有统计学意义(P<0.05);UA S/D值≥3孕妇的新生儿Apgar评分为(6.67±1.41)分,明显低于UA S/D值<3孕妇的(8.11±1.67)分,UA S/D值≥3孕妇的宫内窘迫发生率为63.75%,明显高于UA S/D值<3孕妇的18.33%,差异均有统计学意义(P<0.05);无反应型孕妇的新生儿Apgar评分为(6.47±1.33)分,明显低于反应型的(8.04±1.51)分,宫内窘迫发生率为65.22%,明显高于反应型的21.37%,差异均有统计学意义(P<0.05);MCA、UA S/D值和NST三者联合诊断胎儿宫内窘迫的灵敏度、特异度和准确度分别为87.50%、92.19%、90.50%,明显高于各单项检查,差异均有统计学意义(P<0.05)。结论宫内窘迫发生时,胎儿MCA、UA的血流参数均会出现异常改变,NST监测结果多表现为无反应型。MCA、UAS/D值联合NST能够较为准确地对胎儿宫内窘迫进行预测。

Objective To research the diagnostic value of systolic and diastolic velocity ratio(S/D)of middle cerebral artery(MCA)and umbilical artery(UA)and no stimulation of fetal heart rate monitoring(NST)in predicting fetal distress.Methods A total of 200 pregnant women who underwent prenatal examination in Huidong People’s Hospital from January 2020 to March 2021 were selected as the research objects.According to the diagnostic criteria of intrauterine fetal distress,all pregnant women were divided into intrauterine distress group(73 cases)and non-intrauterine distress group(127 cases).Two groups of pregnant women were tested for MCA,UA blood flow,and NST before delivery.The S/D ratio of MCA and UA and the monitoring results of NST were compared between the two groups.The Apgar score,distribution and incidence of intrauterine distress of pregnant women with different S/D ratios of MCA and UA,different NST monitoring results were compared.The sensitivity,specificity,and accuracy of MCA S/D ratio,UA S/D ratio,NST monitoring and their combination in the diagnosis of fetal distress were compared.Results In the intrauterine distress group,the MCA S/D value was 2.87±0.61,which was significantly lower than 3.81±0.79 in non-intrauterine distress group;the UA S/D value was 3.46±0.63,which was significantly higher than 2.74±0.55 in non-intrauterine distress group;the proportion of nonresponsive type in intrauterine distress group(61.64%)was significantly higher than that in non-intrauterine distress group(18.90%);the differences were statistically significant(P<0.05).The neonatal Apgar score of pregnant women with MCA S/D value<3 was(6.58±1.33)points,which was significantly lower than(8.08±1.57)points of the pregnant women with MCA S/D value≥3;the incidence of intrauterine distress was 65.33%,significantly higher than 19.20%of pregnant women with MCA S/D≥3;the differences were statistically significant(P<0.05).The newborn Apgar score of pregnant women with UA S/D≥3 was(6.67±1.41)points,which was significantly lower than(8.11±1.67)points of pregnant women with UA S/D<3;the incidence of intrauterine distress was 63.75%,significantly higher than 18.33%for pregnant women with UA S/D value<3;the differences were statistically significant(P<0.05).The Apgar score of newborns of non-responsive pregnant women was(6.47±1.33)points,which was significantly lower than(8.04±1.51)points of reactive type;the incidence of intrauterine distress was 65.22%,significantly higher than 21.37%of reactive type;the differences were statistically significant(P<0.05).The sensitivity,specificity,and accuracy of the combination of MCA S/D,UA S/D,and NST in diagnosing fetal distress were 87.50%,92.19%,90.50%,which were significantly higher than those of single index,and the differences were statistically significant(P<0.05).Conclusion When intrauterine distress occurs,and the blood flow parameters of fetal MCA and UA will have abnormal changes,and the results of NST monitoring are mostly non-responsive.The S/D value of MCA and UA combined with NST can predict fetal distress more accurately and is worthy of active clinical promotion.