彩色多普勒超声用于估计宫内发育迟缓胎儿预后的意义

The prognostic significance of blood flow monitoring by color Doppler ultrasound in IUGR fetus

目的 探讨彩色多普勒超声血流监测胎儿宫内发育迟缓 (IUGR)对估计出生时预后的临床意义。方法 回顾性分析 1990～ 2 0 0 2年 75例IUGR胎儿分娩前脐带及脑血流波形改变与出生时情况。结果 脐带血流异常组的IUGR胎儿出生后 1minApgar评分≤ 7分、脐带动脉血 pH <7 2 0及转入新生儿抢救中心治疗的围生儿明显高于脐带血流正常组。以脐带血流波形阻力指数 >2个标准差为异常临界值 ,预测Apgar≤ 7分的敏感度、特异性分别为 77 3%和 6 6 0 % ;预测脐带动脉血 pH <7 2 0的敏感度、特异性分别为 82 6 %和 6 9 4 %。大脑中动脉血流指数与IUGR胎儿预后差异无显著性意义。

Objective To discuss the clinical significance of monitoring the blood flow in IUGR fetus.Methods We retrospectively analysed the antepartum wave forms of umbilical and cerebral blood flow in 75 IUGR fetuses(1990～2002),and the results of the fetal conditions at birth.Results The number of fectuses with apgar score ≤7,pH value of umbilical artery <7 20 and transferance to NICU of cases with abnormal umbilical blood flow was significantly larger than those with normal one(P<0 01).Taking the resistance index of umbilical blood flow higher than 2SD as critical abnormal value,the sensitivity and specificity of predicting Apgar score ≤7 was 77 3% and 66 0%,respectively,predicting pH value of umbilical artery <7 20 was 82 6% and 69 4%,respectively.The index of middle cerebral artery was not significant in predicting the fetal prognosis.Conclusion Monitoring the wave flow of umbilical artery in IUGR fetus plays an important role in predicting the prognosis.