| 熊常君,陈秋玲,邓 卉,郑 晓,张 鹭.孕妇UtA与胎儿UmA和MCA测量在胎儿宫内窘迫诊断中的价值[J].,2020,(4):942-746 |
| 孕妇UtA与胎儿UmA和MCA测量在胎儿宫内窘迫诊断中的价值 |
| The Value of Uterine Artery and Fetal Umbilical Artery and Middle Cerebral Artery Measurement in the Diagnosis of Fetal Distress |
| 投稿时间：2019-08-23 修订日期：2019-09-18 |
| DOI：10.13241/j.cnki.pmb.2020.04.030 |
| 中文关键词: 孕妇 胎儿 宫内窘迫 子宫动脉 大脑中动脉 脐动脉 诊断 价值 |
| 英文关键词: Pregnant women Fetus Intrauterine distress Uterine artery Middle cerebral artery Umbilical artery Diagnosis Value |
| 基金项目:重庆市卫生计生委中医药科技项目（ZY201802066） |
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| 中文摘要: |
| 摘要 目的：探讨胎儿大脑中动脉（Middle cerebral artery，MCA）与脐动脉（umbilical artery，UmA）和孕妇子宫动脉（uterine artery，UtA）测量诊断胎儿宫内窘迫的临床价值。方法：将我院自2017年1月至2019年1月间收治的孕晚期发生胎儿宫内窘迫的孕妇80例作为研究组，选择同期入院各项指标正常的健康孕妇78例作为对照组，对比观察两组胎儿MCA与UmA和孕妇UtA预测胎儿窘迫的价值及胎儿MCA与UmA与新生儿Apgar评分的相关性。结果：研究组孕妇UtA血流参数脐血流搏动指数(pulsatility index，PI)、脐血流阻力指数(resistance index，RI)和收缩/舒张比(systole/diastole ratios，S/D)指标水平均明显高于对照组，研究组胎儿MCA血流参数PI、S/D均明显低于对照组，研究组患儿UmA的血流参数PI和S/D高于对照组（P＜0.05），RI比较差异无统计学意义（P>0.05）；研究组新生儿Apgar评分≤7分的比例为40.00%，明显高于对照组15.38%。研究组UmA-PI、UmA-RI和UmA-S/D 随着Apgar评分的降低呈现升高的趋势，MCA-PI、MCA-S/D和MCA-S/D随着Apgar评分的降低呈现逐渐减低的趋势。UtA血流参数联合MCA血流参数诊断胎儿宫内窘迫的敏感度为97.50%，特异性为96.25%，均明显高于各项参数单独诊断在的敏感度和特异性（P＜0.05）。结论：临床可利用孕晚期孕妇UtA、胎儿UmA和MCA的血流动力学参数改变来预测胎儿宫内窘迫发生的几率，根据胎儿UmA和MCA的血流指标随着Apgar评分的变化趋势，可指导临床早期干预，降低胎儿出生缺陷和死亡率，临床价值较高，可推广使用。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical value of uterine artery and fetal umbilical artery and middle cerebral artery in the diagnosis of fetal distress. Methods: A total of 80 pregnant women with intrauterine distress in the third trimester of pregnancy from January 2017 to January 2019 were enrolled as the study group. 78 healthy pregnant women with normal indexes were selected as the control group. The value of fetal MCA and UmA and maternal UtA predicting fetal distress and the correlation between fetal MCA and UmA and neonatal Apgar score. Results: The RI, PI and S/D levels of UtA blood flow parameters in the study group were significantly higher than those in the control group(P<0.05). The PI and blood flow parameters of the fetal MCA in the study group were significantly lower than those in the control group(P<0.05). The blood flow of the UmA in the study group The parameters of PI and S/D were higher than those of the control group (P<0.05), and the difference of RI was not statistically significant (P>0.05). The proportion of neonatal Apgar score ≤7 in the study group was 40.00 %, which was significantly higher than that in the control group (15.38 %). The study group UmA-PI, UmA-RI and UmA-S/D showed an increasing trend with the decrease of Apgar score. MCA-PI, MCA-S/D and MCA-S/D gradually decreased with the decrease of Apgar score. Reduce the trend. The sensitivity of UtA blood flow parameters combined with MCA blood flow parameters in the diagnosis of fetal distress was 97.50%. The specificity was 96.25%, which was significantly higher than the sensitivity and specificity of each parameter (P<0.05). Conclusion: Clinically, the hemodynamic parameters of UtA and fetal MCA and UmA can be used to predict the incidence of intrauterine distress. According to the trend of the blood flow index of the fetal UmA and MCA along with the Apgar score, it can guide early clinical intervention, reduce fetal birth defects and mortality, and has high clinical value, can be promoted. |
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