胎心监护联合脐动脉、大脑中动脉及静脉导管分流率预测胎儿宫内窘迫的价值

Value of fetal heart monitoring combined with umbilical artery, middle cerebral artery and venous catheter shunt rate for predicting fetal distress

目的探讨胎心监护联合彩色多普勒超声检测脐动脉、大脑中动脉和静脉导管分流率对胎儿宫内窘迫的预测价值。方法选取在我院产科2013年1月至2015年3月接受治疗的胎儿宫内窘迫孕妇80例为观察组,选择同期正常体检孕妇80例为对照组,所有胎儿均行胎心监护,彩色多普勒超声检测胎儿脐动脉(UA)和大脑中动脉(MCA)的阻力指数(RI)、搏动指数(PI)、S/D值,并计算静脉导管分流率(VCSR)。结果观察组胎心监护的敏感性为63.75%(51/80)、特异性为78.75%(63/80)和阳性率为68.75%(55/80),均低于胎心监护联合检测的92.50%(74/80)、96.25%(77/80)和93.75%(75/80),且差异均有统计学意义(P<0.05);观察组和对照组胎儿UA的RI[(0.91±0.13)vs(0.76±0.08)]、PI[(2.23±0.27)vs(1.74±0.31)]和S/D值[(6.85±1.52)vs(5.04±1.21)]比较,观察组均显著高于对照组,差异均有显著统计学意义(P<0.01);观察组和对照组胎儿MCA的RI[(0.63±0.09)vs(0.78±0.11)]、PI[(1.13±0.23)vs(1.57±0.28)]以及S/D值[(3.12±0.54)vs(4.35±1.01)]比较,观察组均显著低于对照组,差异均有显著统计学意义(P<0.01);观察组VCSR为(61.28±5.86)%,显著高于对照组的(39.21±7.13)%,差异有显著统计学意义(P<0.01)。结论胎心监护联合脐动脉、大脑中动脉和静脉导管分流率检测对胎儿宫内窘迫具有较好的预测价值。

Objective To investigate the value of fetal heart monitoring combined with color Doppler ultrasonography for detecting shunt rate of umbilical artery, middle cerebral artery and venous catheter in predicting fetal distress. Methods Eighty cases of pregnant women with intrauterine fetal distress in Department of Obstetrics and Gynecology in our hospital from January 2013 to March 2015 were selected as the observation group, and 80 cases of normal pregnant women were selected as control group at the same period. All fetuses underwent fetal heart monitoring. The fe-tal resistance index(RI), pulsatility index(PI), S/D value of the umbilical artery(UA) and middle cerebral artery(MCA)were detected by color Doppler ultrasound. The venous catheter shunt rate(VCSR) were calculated. Results In observation group, the sensitivity, specificity and the positive rate of fetal heart monitoring were significantly lower than those in combined detection of fetal heart monitoring(63.75%(51/80) vs 92.50%(74/80), 78.75%(63/80) vs 96.25%(77/80),68.75%(55/80) vs 93.75%(75/80)), with statistically significant difference(P<0.05). The RI, PI and S/D value of UA of observation group, which were significantly higher than those of control group((0.91±0.13)vs(0.76±0.08),(2.23±0.27)vs(1.74±0.31),(6.85±1.52) vs(5.04±1.21)), with statistically significant difference(P<0.01). The RI, PI and S/D value of MCA of observation were significantly lower than those of control group((0.63 ± 0.09) vs(0.78 ± 0.11),(1.13 ± 0.23) vs(1.57±0.28),(3.12±0.54) vs(4.35±1.01)), with statistically significant difference(P<0.01). The VCSR(61.28±5.86)% in the observation group was significantly higher than that in the control group(39.21±7.13)%, with statistically significant difference(P<0.01). Conclusion Fetal heart monitoring combined with umbilical artery, middle cerebral artery and venous catheter shunt rate has a good predictive value for intrauterine fetal distress.