超声观察妊娠期肝内胆汁淤积症胎儿动脉血流动力学变化的研究

摘要

Objective To evaluate the fetal hemodynamic changes on color Doppler ultrasound for early detection of intrauterine hypoxia in intrahepatic cholestasis of pregnancy(ICP).Methods 86 pregnant women with ICP and 100 normal subjects were enrolled in the study.The peak systolic and diastolic velocities,resistive indices(RI),pulsatility indices(PI)of fetal renal artery,middle cerebral artery,and umbilical artery systolic/diastolic velocity ratio(S/D)were measured on color Doppler ultrasound.The parameter ratios were calculated and analyzed.Results The RI and PI of fetal renal arteries were significantly higher in ICP than those of normal control(P<0.05).The velocities of MCA were significantly higher whereas the RI and PI were significantly lower in ICP(P<0.05). There was no significant difference in umbilical artery S/D between the ICP and control groups(P>0.05).The ratios of RI and PI of renal arteries to middle cerebral arteries were significantly higher in ICP than those in the normal group(P<0.01).Conclusions Fetuses of mothers with ICP may suffer from intrauterine hypoxia.Hemodynamic changes in the fetuses are reflected by higher RI and PI ratios between fetal renal and middle cerebral arteries.Color Doppler ultrasound may allow early detection and treatment of fetal hypoxia.%　　目的通过超声观察晚期妊娠肝内胆汁淤积症(ICP)胎儿肾动脉(RA)、大脑中动脉(MCA)及脐动脉(UA)血流动力学参数变化,了解胎儿的血流灌注情况,探讨ICP胎儿有无可提示宫内缺氧的动脉血流指标.方法ICP组86例,对照组100例,在胎儿肾门部测量肾动脉Vs、Vd、RI、PI,两侧取平均值；测量近场侧大脑中动脉Vs、Vd、RI、PI；在脐带与胎盘连接处测量脐动脉S/D值,比较以上参数.另外,比较两组胎儿肾动脉和大脑中动脉RI、PI的比值,即RIRA/RIMCA及PIRA/PIMCA.结果ICP组与对照组相比,肾动脉RI、PI增高,大脑中动脉流速增高,RI、PI减低,差异有统计学意义(P<0.05),脐动脉S/D无明显差异；ICP组RIRA/RIMCA、PIRA/PIMCA较对照组明显增高(P<0.01).结论ICP胎儿外周血管收缩,中央血管扩张,血流量增加,存在宫内缺氧的可能性,通过胎儿肾动脉及大脑中动脉血流动力学检测可以早期判断ICP胎儿的循环状况,RIRA/RIMCA及PIRA/PIMCA能更敏感、可靠地反映胎儿循环状态,超声为产前了解ICP胎儿宫内状况提供了一条新途径.