产前彩色多普勒超声联合NST对高危孕妇胎儿宫内窘迫的预测价值

Predictive value of prenatal color Doppler ultrasound combined with none-stress test for fetal distress in high-risk pregnant women

目的探究产前彩色多普勒超声联合无应激试验(NST)对高危孕妇胎儿宫内窘迫的预测价值。方法选择2020年8月至2021年9月在广州市增城区人民医院接受产检和治疗的60例高危妊娠孕妇作为研究对象,其中23例胎儿宫内窘迫孕妇为窘迫组,其余37例孕妇为正常组。两组孕妇在产前均行彩色多普勒超声和NST检查,对比两组胎儿的大脑中动脉(MCA)、脐动脉(UA)的血流频谱参数和NST检查结果。比较不同诊断方式诊断胎儿宫内窘迫的阳性检出率,采用受试者工作特征曲线(ROC)分析彩色多普勒超声、NST单项诊断及联合检查预测胎儿宫内窘迫的诊断效能。结果窘迫组胎儿MCA的搏动指数(PI)、阻力指数(RI)、收缩期与舒张期流速比值(S/D)分别为1.37±0.25、0.63±0.19、3.24±0.51,明显低于正常组的1.91±0.36、0.89±0.27、4.42±0.67;UA的PI、RI和S/D值分别为1.89±0.33、0.68±0.18、3.02±0.46,明显高于正常组的1.44±0.21、0.55±0.13、2.41±0.34,差异均有统计学意义(P<0.05);窘迫组胎儿的胎心监护异常率为69.57%,明显高于正常组的21.62%,差异有统计学意义(P<0.05);窘迫组胎儿的彩色多普勒超声、NST和联合检查诊断胎儿宫内窘迫的阳性检出率分别为82.61%、69.57%、95.65%,明显高于正常组的16.22%、21.62%、8.11%,差异均有统计学意义(P<0.05);联合检查诊断胎儿宫内窘迫的灵敏度和特异度分别为95.65%、91.89%,高于彩色多普勒超声的82.61%、83.78%和NST的69.57%、78.38%,联合检查的ROC曲线下面积(AUC)为0.938,高于彩色多普勒超声的0.810和NST的0.740,联合检查的诊断效能最高。结论彩色多普勒超声、NST检查能够从不同角度对胎儿宫内窘迫进行诊断,两者联合能够显著提高胎儿宫内窘迫的预测准确率,可为早期临床干预提供重要参考。

Objective To research the predictive value of prenatal color Doppler ultrasound combined with none-stress test(NST)in high-risk pregnant women with fetal distress.Methods Sixty pregnant women with high risk who were examined and treated in Guangzhou Zengcheng People's Hospital from August 2020 to September 2021 were selected as the study objects,of which 23 with intrauterine distress were enrolled as distress group,and the remaining 37 were enrolled as normal group.All the patients received prenatal color Doppler ultrasound and NST examination,and the blood flow spectrum parameters and NST results of MCA and UA were compared.The positive detection rate of fetal distress was compared among different diagnosis methods.The receiver operator characteristic curve(ROC)was used to analyze the diagnostic efficiency of color Doppler ultrasound alone,NST alone,and combined examination in predicting fetal distress.Results The pulsatility index(PI),resistance index(RI),systolic and diastolic velocity ratio(S/D)of MCA in distress group were 1.37±0.25,0.63±0.19,3.24±0.51,which were significantly lower than 1.91±0.36,0.89±0.27,4.42±0.67 in the normal group;the PI,RI,and S/D of UA were 1.89±0.33,0.68±0.18,3.02±0.46,which were significantly higher than 1.44±0.21,0.55±0.13,2.41±0.34 in the normal group;the differences were statistically significant(P<0.05).The abnormal rate of fetal heart monitoring in the distress group was 69.57%,which was significantly higher than 21.62%in the normal group(P<0.05).The positive detection rates of fetal distress in color Doppler ultrasound alone,NST alone,and combined examination in the distress group were 82.61%,69.57%,and 95.65%,respectively,which were significantly higher than 16.22%,21.62%,and 8.11%in the normal group(P<0.05).The sensitivity and specificity of combined examination in the diagnosis of fetal distress were 95.65%and 91.89%,respectively,which were significantly higher than 82.61%and 83.78%of color Doppler ultrasound and 69.57%and 78.38%of NST.The area under curve(AUC)of combined examination was 0.938,which was significantly higher than 0.810 of color Doppler ultrasound and 0.740 of NST.The diagnostic efficiency of combined examination was the highest.Conclusion Color Doppler ultrasound and NSTexamination can both diagnose fetal distress from different angles,and the combination of the two can significantly further improve the prediction accuracy of fetal distress and can provide important reference for early clinical intervention.