胎儿肺动脉超声多普勒流速曲线收缩期加速时间／射血时间比值产前预测新生儿呼吸窘迫综合征的价值

摘要

目的探讨胎儿肺动脉超声多普勒流速曲线收缩期加速时间／射血时间（AT／ET）比值产前预测新生儿呼吸窘迫综合征（NRDS）的价值。方法对49例早产单胎孕妇应用超声多普勒测量胎儿主肺动脉中段、左（或右）肺动脉中段和肺内动脉近段AT／ET比值。根据新生儿结局，将49例研究对象分为NRDS组和非NRDS组，比较两组胎儿AT／ET比值在3个不同多普勒取样位置间的差异和产前预测NRDS的效率。结果多普勒取样框分别放置在胎儿主肺动脉中段、左（或右）肺动脉中段和肺内动脉近段，获得满意多普勒流速曲线的胎儿分别为49例（49／49，100％）、45例（45／49，91．8％）和14例（14／49，28．6％）。 NRDS组胎儿主肺动脉中段AT／ET比值低于非NRDS组，且差异有统计学意义（0．197±0．015 vs 0．232±0．018，t＝－5．659，P＜0．001），两组胎儿左（或右）肺动脉中段、肺内动脉近段AT／ET比值差异无统计学意义。胎儿主肺动脉中段AT／ET比值以0．215为切割值，受试者操作特性曲线下面积为0．958，产前预测NRDS的敏感度和特异度分别为1．000和0．897。结论胎儿主肺动脉多普勒AT／ET比值可能是一个非常有潜力的产前无创性预测NRDS的参数。%Objective To explore the prenatal predictive value of neonatal respiratory distress syndrome(NRDS) by Doppler waveform systolic acceleration time/ejection time(AT/ET) ratio in the fetal pulmonary arteries.Methods Fourty nine cases of singleton pregnant women with premature outcome underwent ultrasonic Doppler measurement of AT/ET ratio in the middle of fetal main pulmonary artery ,in the middle of the left (or right) branch pulmonary artery and in the proximal segment of pulmonary artery . According to the clinical neonatal outcome ,49 subjects were divided into NRDS group and non-NRDS group. The values of AT/ET ratio were compared between groups in the three different Doppler sampling points respectively and prenatal predictive efficiency of AT/ET ratio in NRDS was also assessed.Results Doppler sampling points were placed in the middle of fetal main pulmonary artery ,the middle of the left (or right) branch pulmonary artery and the proximal segment of pulmonary artery .Satisfied Doppler waveforms were obtained in 49 cases(100%,49/49),45 cases(91.8%,45/49)and 14 cases(28.6%,14/49)respectively. In the middle of fetal main pulmonary artery ,AT/ET ratio in NRDS group was significantly lower than that in non-NRDS group (0.197 ±0.015 vs 0.232 ±0.018,t =-5.659,P <0.05).However there were no statistical differences of AT/ET ratio in the middle of the left (or right) branch pulmonary artery and the proximal segment of pulmonary artery .The cut-off value of AT/ET ratio in the middle of fetal main pulmonary artery for prenatal predicting NRDS was 0.215 and the area under receiver operating characteristic curve was 0.958,with the sensitivity and specificity of 1.000 and 0.897 respectively.Conclusion Doppler AT/ET ratio in the fetal main pulmonary artery may be a promising and non-invasive parameter to predict NRDS prenatally.