胎儿超声MCA、UA及DV指标预测胎儿宫内缺氧价值

Value of the fetal hemodynamic parameters of fetal middle cerebral artery,umbilical artery,and umbilical ductus venosus that examined by color Doppler ultrasound for predicting fetal intrauterine hypoxia

目的:探究彩色多普勒超声下胎儿大脑中动脉(MCA)、脐动脉(UA)及脐静脉导管(DV)血流动力学参数对胎儿宫内缺氧的诊断价值。方法:选取2019年1月-2020年8月诊断为胎儿宫内缺氧的孕晚期产妇(孕36~41^(+6)周)85例为病例组,无胎儿宫内缺氧诊断孕晚期产妇150例为对照组,入院时行彩色多普勒超声检查,检测MCA、UA的阻力指数(RI)、搏动指数(PI)、收缩期峰值流速/舒张末期流速(S/D)值,并计算MCA与UA各参数比值(RI_(MCA/UA)、PI_(MCA/UA)、S/D_(MCA/UA)),测量脐静脉血流量(QUV)、DV血流量(QDV),计算DV分流率,比较两组上述参数差异并绘制受试者工作特征曲线(ROC),探究各指标对胎儿宫内缺氧预测价值。结果:病例组胎儿MCA的RI、PI及S/D值均低于对照组,UA的RI、PI及S/D值均高于对照组,RI_(MCA/UA)、PI_(MCA/UA)、S/D_(MCA/UA)均低于对照组(均P<0.05);两组QDV无差异(P>0.05),但病例组QUV低于对照组、DV分流率大于对照组(P<0.05);RI_(MCA/UA)、PI_(MCA/UA)、S/D_(MCA/UA)、DV分流率及4项联合诊断胎儿宫内缺氧的ROC曲线下面积分别为0.784、0.802、0.830、0.835、0.967(P<0.05)。结论:胎儿宫内缺氧早期可表现出MCA、UA及DV血流动力学参数改变,MCA与UA的RI、PI、S/D比值及DV分流率联合检测对胎儿宫内缺氧有较高预测价值。

Objective:To explore the value of hemodynamic parameters of fetal middle cerebral artery(MCA),umbilical artery(UA),and umbilical ductus venosus(DV)that examined by color Doppler ultrasound for diagnosing fetal intrauterine hypoxia.Methods:From January 2019 to August 2020,85 pregnant women with fetal intrauterine hypoxia during the third trimester of pregnancy(36-41^(+6) gestational weeks)were selected in study group,and another 150 pregnant women without fetal intrauterine hypoxia during the third trimester of pregnancy were selected in control group.Color Doppler ultrasound examination of the women in the two groups was performed at admission.The resistance index(RI),pulsatility index(PI),and systolic flow velocity peak/diastolic flow velocity end(S/D)of MCA and UA of the women were detected.The values of fetal MCA and UAM parameters,such as RI,PI,and S/D,in the two groups were calculated,and the values of fetal umbilical venous blood flow(QUV)and DV blood flow(QDV)in the two groups were measured.The fetal DV shunt rate in the two groups was calculated,and the differences of the above fetal parameters were compared between the two groups.The receiver operating characteristic curve(ROC curve)was drawn to explore the predictive value of RI,PI,S/D of MCA and UA,and DV shunt rate for fetal intrauterine hypoxia.Results:The values of RI,PI,and S/D values of fetal MCA in the study group were significant lower than those in the control group,but the values of RI,PI,and S/D of fetal MCA in the study group were significant higher than those in the control group.The values of RI,PI and S/D of fetal MCA/UA in the study group were significantly lower than those in the control group(all P<0.05).There was no significant difference in fetal QDV value between the two groups(P>0.05),but fetal QUV value in the study group was significantly lower than that in the control group,DV shunt rate in the study group was significant higher(P<0.05).The areas under ROC curve of the RI value,PI value,and S/D value of MCA/UA,and the DV value,and the combined values of RI,PI,S/D of MCA/UA,and DV for diagnosing fetal intrauterine hypoxia were 0.784,0.802,0.830,0.835,0.967,respectively(P<0.05).Conclusion:Early fetal intrauterine hypoxia has the changes of the hemodynamic parameters,such as MCA,UA,and DV.Combined examination of RI,PI,and S/D of MCA and UA,and DV shunt rate by ultrasound has higher value for predicting fetal intrauterine hypoxia.