彩色多普勒血流显像测定脐动脉、大脑中动脉、静脉导管及主动脉弓峡部血流参数对胎儿生长受限的诊断价值

Diagnostic value of umbilical artery,middle cerebral artery,ductus venosus and aortic isthmus blood flow parameters measured by color Doppler flow imaging in fetal growth restriction

目的分析彩色多普勒血流显像(CDFI)测定脐动脉、大脑中动脉、静脉导管及主动脉弓峡部血流参数对胎儿生长受限(FGR)的诊断价值。方法选取于我院分娩并确诊为FGR的52例孕妇作为观察组,同期正常妊娠的40例孕妇作为对照组。以CDFI测定两组胎儿脐动脉、大脑中动脉、静脉导管及主动脉弓峡部血流参数并进行组间比较。分析各血流参数对FGR的诊断效能。比较两组的妊娠结局及围生期情况。结果观察组胎儿脐动脉的RI、PI、S/D均高于对照组(P<0.05)。观察组胎儿大脑中动脉的RI、PI、S/D均低于对照组(P<0.05)。观察组胎儿静脉导管S峰流速、a波流速低于对照组,S/a高于对照组(P<0.05)。观察组胎儿主动脉弓峡部ESRV高于对照组,PSV/ESRV低于对照组(P<0.05)。ROC曲线分析结果显示,脐动脉、大脑中动脉、静脉导管、主动脉弓峡部血流参数均能较好地诊断FGR,AUC范围为0.632~0.915(P<0.05);大脑中动脉血流参数诊断FGR的AUC相对更大,且其中PI的AUC最大。观察组的胎儿窘迫、低体重儿、新生儿窒息发生率均高于对照组(P<0.05);观察组1 min Apgar评分≥8分的胎儿占比明显低于对照组(P<0.05)。结论采用CDFI监测脐动脉、大脑中动脉、静脉导管、主动脉弓峡部的血流参数有助于早期准确地发现FGR,临床价值高。

Objective To analyze the diagnostic value of umbilical artery,middle cerebral artery,ductus venosus and aortic isthmus blood flow parameters measured by color Doppler flow imaging(CDFI)in fetal growth restriction(FGR).Methods Fifty-two pregnant women diagnosed with FGR in our hospital were selected as observation group and 40 pregnant women with normal pregnancy in the same period were selected as control group.The blood flow parameters of umbilical artery,middle cerebral artery,ductus venosus and aortic isthmus were measured by CDFI and compared between the two groups.The diagnostic efficacy of blood flow parameters on FGR was analyzed.The pregnancy outcomes and perinatal conditions of the two groups were compared.Results The RI,PI and S/D of fetal umbilical artery in the observation group were higher than those in the control group(P<0.05).The RI,PI and S/D of fetal middle cerebral artery in the observation group were lower than those in the control group(P<0.05).The S peak velocity and a wave velocity of fetal ductus venosus in the observation group were lower than those in the control group,while the S/a was higher than that in the control group(P<0.05).ESRV of fetal aortic isthmus in the observation group was higher than that in the control group,while PSV/ESRV was lower than that in the control group(P<0.05).The ROC curve analysis showed that the blood flow parameters of umbilical artery,middle cerebral artery,ductus venosus and aortic isthmus could better diagnose FGR,and the AUC range was 0.632-0.915(P<0.05);the AUC of blood flow parameters of middle cerebral artery in the diagnosis of FGR was relatively larger,and the AUC of PI was the largest.The incidences of fetal distress,low birth weight infants and neonatal asphyxia in the observation group were higher than those in the control group(P<0.05);the proportion of fetuses with Apgar score≥8 in the observation group was significantly lower than that in the control group(P<0.05).Conclusion CDFI monitoring the blood flow parameters of umbilical artery,middle cerebral artery,ductus venosus and aortic isthmus is helpful to find FGR early and accurately,which has high clinical value.