孕中期超声监测子宫动脉血流动力学参数及平均动脉压对妊娠期高血压的预测价值探讨

Predictive value of uterine artery hemodynamic parameters and mean arterial pressure by ultrasound in the second trimester of gestational hypertension

目的:探究孕中期超声监测子宫动脉血流动力学参数及平均动脉压对妊娠期高血压的预测价值。方法:选取我科2019年2月至2021年5月期间收治的75例妊娠期高血压疾病孕妇为观察组,同期75例正常孕妇作为对照组,均于孕中期(孕28~32 w)应用多普勒超声监测子宫动脉参数及平均动脉压,对比两组子宫动脉血流动力学参数、平均动脉压(Mean arterial pressure,MAP)、胎儿脐动脉血流动力学参数、母婴结局。采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析MAP、子宫动脉血流动力学参数及胎儿脐动脉血流动力学参数对妊娠期高血压孕妇的相关性,及对母婴结局的影响。结果:观察组子宫动脉搏动指数(Pulsatility index,PI)、阻力指数(Resistive index,RI)、收缩压最大血流速度与舒张末期最大血流速度比值(Maximum systolic blood flow velocity/Maximal end-diastolic flow velocity,S/D)、MAP、胎儿脐动脉PI、RI、S/D、早产率、新生儿窒息发生率均高于对照组,新生儿体质量、Apgar评分低于对照组(P<0.05)。经ROC分析得知,子宫动脉PI、RI、S/D和MAP诊断妊娠期高血压疾病的AUC分别为0.984、0.956、0.820、0.929,脐动脉PI、RI、S/D诊断妊娠期高血压疾病的AUC分别为0.989、0.824、0.820,均具有较高的特异度和敏感度。结论:孕中期超声监测子宫动脉、胎儿脐动脉血流动力学参数联合MAP利于对筛查妊娠期高血压。

Objective:To explore the prediction value of uterine arterial hemodynamics parameters and mean arterial pressure monitored by ultrasound during the middle trimester for gestational hypertension.Methods:75 pregnant women with gestational hypertension from February 2019 to May 2021 in our department were selected as the observation group,and 75 normal pregnant women as the control group during the same period.Uterine artery parameters and mean arterial pressure were monitored by Doppler ultrasound during the second trimester(28-32 weeks of gestation).Hemodynamic parameters of uterine artery,mean arterial pressure(MAP),fetal umbilical artery and maternal and infant outcomes were compared between the two groups.According to Receiver operating characteristic curve(ROC),the correlation of uterine arterial hemodynamics parameters,MAP and fetal umbilical arterial hemodynamics parameters to pregnant women with gestational hypertension was analyzed,as well as their influence on maternal and infant outcomes.Results:Uterine artery pulsatility index(PI),resistance index(RI),ratio of maximum systolic blood flow velocity to maximum end-diastolic blood flow velocity(S/D),MAP,fetal umbilical artery PI,RI,S/D,preterm birth rate,and incidence of neonatal asphyxia in observation group were higher than those in the control group.while the neonatal body weight and apgar score were lower than those in the control group(P<0.05).According to ROC analysis,the area under the curve(AUC)of uterine artery PI,RI,S/D,MAP,and fetal umbilical artery PI,RI,S/D values were 0.929,0.984,0.956,0.820,0.929,AUCs were 0.989,0.824,0.820 and 0.989,0.824,and 0.820 respectively with high specificities and sensitivities.Conclusion:Ultrasound monitoring of uterine artery and fetal umbilical artery blood flow dynamics parameters combined with MAP during the second trimester of pregnancy is beneficial to screen gestational hypertension.