脑-胎盘率与胎心监护联合应用对早期诊断胎儿宫内缺氧的临床意义

摘要

目的：探讨胎儿的脑-胎盘率与胎心监护联合应用对早期诊断胎儿宫内缺氧的临床意义。方法运用彩色多普勒超声检测该院2013年8月—2015年10月收治并分娩的185例孕34~41周的胎儿脐动脉（UA）和大脑中动脉（MCA）血流的搏动指数（PI）计算脑-胎盘率（PIMCA/PIUA），同时进行胎心监护检查，根据结果分为4组：A组为脑-胎盘率及胎心监护均正常；B组为脑-胎盘率正常，胎心监护异常；C组为脑-胎盘率异常，胎心监护正常；D组为脑-胎盘率及胎心监护均异常。对各组的胎儿宫内缺氧率以及新生儿Apgar评分、脐血血气等宫内缺氧指标进行比较。结果 A组胎儿正常比率（98.6%）明显高于其他3个组（83.3%、82.4%、33.3%），差异有统计学意义（P<0.05）；D组胎儿宫内缺氧的发病率（66.7%）明显高于B 、C组（16.7%、17.6%），差异有统计学意义（P<0.05），而B、C组（16.7%、17.6%）之间的差异无统计学意义（P>0.05）。结论脑-胎盘率与胎心监护联合应用对早期诊断胎儿宫内缺氧中起着非常重要的作用，弥补单一方法的不足，提高了诊断的准确性，具有重要的临床意义。%Objective To explore the clinical significance of cerebro-placenta ratio combined with cardiac monitoring in early diagnosis of fetal intrauterine hypoxia. Methods Color doppler ultrasound was used to obtain the blood flow pulsation index(PI) of fetal umbilical artery(UA) and middle cerebral artery (MCA) of 185 cases of 34 ~ 41 weeks of pregnant women enrolled in our hospital from the August of 2013 to the October of 2015. The cerebro-placenta ratio was calculated and the cardiac monitoring inspections was performed at the same time. According to the results, four groups were divided: group A with both normal cerebro-placenta ratio and cardiac monitoring; group B with normal cerebro-placenta ratio and abnormal cardiac monitoring; group C with abnormal cerebro-placenta ratio and normal cardiac monitoring; group D with both abnor-mal cerebro-placenta ratio and cardiac monitoring. And the rates of fetal intrauterine hypoxia and other indexes concerning with fetal intrauterine hypoxia including the neonatal Apgar score and the umbilical cord blood gas analysis of four groups were compared and analyzed. Results The rate of normal fetal of group A (98.6%)was significantly higher than other three groups(83.3%、82.4%、33.3%), and the difference was statistically significant(all P<0.05). The rate of fetal intrauterine hy-poxia of group D(66.7%)was obviously highter than those of group B and C(16.7%、17.6%), and the difference was statisti-cally significant(all P<0.05);and there was no significant difference between group B and C(16.7%、17.6%)(P<0.05). Con-clusion The cerebro-placenta ratio combined with cardiac monitoring plays an important role in early diagnosis of fetal in-trauterine hypoxia, which makes up the lack of a single method. It improves the diagnostic accuracy and has an important clinical significance.