胎儿宫内缺氧彩色多普勒超声血流显像应用研究

摘要

目的 探讨彩色多普勒血流显像检测胎儿脑、肾动脉及脐动脉血流动力学变化,对产前胎儿宫内缺氧(FIUA)的预测价值.方法 应用彩色多普勒血流显像监测49例中晚期正常妊娠及52例宫内缺氧(窘迫)组大脑中动脉(MCA),肾动脉(RA)及脐动脉(UA)收缩期最大血流速度(S)与舒张末期血流速度(D)的比值(S/D)、搏动指数(PI)及阻力指数(RI)并与妊娠结局相对照.结果 正常妊娠组随孕周增加UA的S/D及PI、RI逐渐下降;宫内缺氧组UA的S/D、PI、RI均明显高于正常组,差异有统计学意义(P＜0.01).正常胎儿出生时Apgar评分绝大多数8～10分,宫内缺氧者随宫内缺氧程度的加重,新生儿Apgar分值呈明显下降趋势.结论 产前胎儿MCA血流S/D＜4、PI＜1.6、RI＜0.6时,胎儿UA血流S/D＞3、P＞1.7、RI＞0.8且RA血流S/D＞4、PI＞1.8、RI＞0.8时,可提示胎儿宫内缺氧.胎儿宫内缺氧是导致胎儿窘迫、围生儿死亡的主要原因,检测脑、肾动脉和脐动脉的血流动力学改变对预测胎儿宫内缺氧及不良结局有重要提示意义.%Objective To evaluate the clinical value of hemodynamic changes in fetal predicting intrauterine hypoxia with middle cerebral artery(MCA),renal artery(RA)and umbilical artery(UA)detected by Color Doppler flow imaging(CDFI).Methods CDFI was used to examine the blood flow velocity waveforms of fetal MCA,RA and UA in 49 cases of normal prennancy and 52 cases with fetal intrauterine anoxia.The peak systolic/diastolic ratio(S/D),pulsation index(PI)and resistance index(RI)values of MCA,RA and UA were calculated.Results The peak systolic/diastolic ratio(S/D),pulsation index and resistance index values of MCA,RA and UA in nornlal group were gradually decreased in correspondent to gestational period(P＜0.01).The values of hemodynamic changes of MCA,RA and UA in Intrauterine hypoxia group pregnancies were higher in the normal ones.Conclusion When the S/Dvalue of UA was more than 3,PI more than 1.7,and RI more than 0.8,The blood flow of RA with S/D more than 4,PI more than 1.8,RI more than 0.8,fetal intrauterine hypoxia was suggested.The blood flow with s/D less than 4,PI less than 1.6.RI less than0.6 indicated intrauterine fetal hypoxia.Intrauterine hypoxia is a dominant cause of fetal distress and perinatal death.This study demonstrates that the monitoring of fetal hemodynamic changes in MCA,RA and UA plays an important role in prediction of the fetus development and abnormality.