三维能量多普勒超声评估胎盘血管指数随孕周的变化趋势研究

The evaluation of 3D-PDU on the variation trend of placental vascular index with gestational age and its application value

目的:分析三维能量多普勒超声(3D-PDU)评估胎盘血管指数随孕周的变化趋势及其应用价值。方法:选取在医院妇幼保健门诊常规产前检查的234名孕妇,根据孕妇是否出现妊娠附属品异常及病变将其分为正常对照组(224名)和观察组(10例),两组均行3D-PDU检查,计算胎盘内血管化指数(VI)、血流指数(FI)以及血管化-血流指数(VFI)的数值,分析正常对照组孕妇各孕期的胎盘血管指数,采用曲线拟合分析胎盘血流参数与孕龄的关系。比较两组孕妇胎盘血管指数。结果:正常胎儿胎盘的三维血流参数VI、FI、VFI与孕龄呈曲线相关(r=0.659,r=0.759,r=0.412;P<0.01)。VFI与VI呈曲线相关(r=0.0.812,P<0.01)。观察组超声可疑胎盘植入病理经手术及病理证实为胎盘植入,其中植入型胎盘7例(占70.00%),穿透性胎盘植入3例(占30.00%),孕妇均有剖宫产、多次妊娠及人工流产史,人流史5例(占50.00%)。观察组血流参数VI、VFI水平明显高于正常对照组,FI水平明显低于正常对照组,差异有统计学意义(t=4.328,t=2.198,t=4.948;P<0.05)。结论:3D-PDU是一种简便、客观且无创的检查技术,可定量分析正常胎盘血流灌注情况,为术前诊断胎盘植入提供参考范围。

Objective: To analyze the variation trend of placental vascular index with gestational age by using threedimensional power Doppler ultrasound(3 D-PDU) and its application value. Methods: A total of 234 pregnant women who received routine prenatal examination in maternal and child health clinic of hospital were collected and were divided into normal control group(n=224) and observation group(n=10) according to whether occurred abnormal pregnancy accessories and pathological changes. Both two groups underwent 3 D-PDU examination, and the vascularization index(VI), blood flow index(FI) and vascularization-blood flow index(VFI) within placenta of them were calculated. The placental vascular index of pregnant women in various gestation of normal control group was analyzed. The curve fitting was adopted to analyze the relation between placental blood flow parameter and gestation age. And then, the placental vascular indexes of pregnant women between two groups were compared. Results: The VI, FI and VFI of placental 3 D blood flow parameters of normal fetus were curvilinear correlation with gestational age(r=0.659, r=0.759, r=0.412, P<0.01). There was a curve correlation between VFI and VI(r=0.0.812, P<0.01).In the observation group, the pathological appearances with suspected placental implantation which were diagnosed by ultrasound were confirmed as placental implantation by surgery and pathological examination. Among of them, 7 cases(70.00%) were implantable placenta, 3 cases(30.00%) were placenta implantation with penetrability, and all of them had the histories of cesarean delivery, repeated gestation and induced abortion, and 5 cases had the history of induced abortion(50.00%). In addition, the levels of VI and VFI of blood flow parameters in observation group were significantly higher than those in control group, and the FI level of observation group was significantly lower than that of control group(t=4.328, t=2.198, t=4.948, P<0.05), respectively. Conclusion: 3 D-PDU is a simple, objective and noninvasive examination technique, which can quantitatively analyze the condition of blood perfusion of normal placenta and provide reference range for preoperative diagnosis of placenta implantation.