多普勒超声监测子宫动脉血流参数在高危妊娠结局预测中的应用价值

摘要

目的：：研究子宫动脉高频超声多普勒血流检测对于高危妊娠晚期患者的临床价值。方法：选取120例高危妊娠晚期患者作为观察组,另取100例正常妊娠妇女作为对照组。比较2组产妇的收缩期峰值流速/舒张末期流速( S/D)、子宫动脉评分、搏动指数( PI)及阻力指数( RI)等动脉血流动力参数指标；建立各血流指数的ROC 曲线,记录并比较观察组中不同S/D值的产妇其胎儿产出后的体质量、生长受限及窒息的比例。结果：观察组的S/D值为2.93±1.04,PI 0.73±0.19,RI 1.39±0.82,三者均明显高于对照组的2.21±0.29、0.54±0.12、1.08±0.37(P<0.01)；观察组中S/D值≥2.8的产妇产后胎儿体质量(3192±204)g,明显低于S/D值<2.8的产妇产后胎儿体质量(3327±284)g(P<0.01)；S/D值≥2.8的产妇产后胎儿生长受限率68.12%、窒息率42.03%,均明显高于 S/D值<2.8的产妇产后胎儿生长受限率19.61%、窒息率13.73%( P<0.01)；早产、小于胎龄儿与剖宫产的PI、RI、SD参数在ROC曲线下面积均逐渐减少。结论：子宫动脉高频超声多普勒可监测高危妊娠晚期患者的动脉血流动力参数异常,根据S/D值判定患者病情的严重程度,具有一定的临床应用价值。%Objective:To investigate the clinical value of the uterine artery blood flow detected by Doppler ultrasound in predicting the high-risk pregnancy outcome. Methods:One hundred and twenty high-risk pregnancy patients and 100 normal pregnant women were divided into the observation group and control group,respectively. The peak systolic velocity/end diastolic velocity( S/D) ,uterine artery score,pulsatility index(PI) and resistance index(RI) between two groups were analyzed,and the ROC curve were established. The different S/D values of maternity,and the weight,growth restriction and proportion of suffocation of newborn in observation group were recorded. Results:The S/D value,PI and RI in observation group(2. 93 ± 1. 04,0. 73 ± 0. 19 and 1. 39 ± 0. 82) were significantly higher than those in control group(2. 21 ± 0. 29,0. 54 ± 0. 12 and 1. 08 ± 0. 37),respectively(P<0. 01). In observation group,the newborn weight in puerperal with S/D value≥2. 8(3 192 ± 204)g was significantly lower than that in puerperal with S/D value<2. 8 (3 327 ±284 )g(P<0. 01). In observation group,the growth restriction and asphyxia rates of newborn in puerperal with S/D value≥2.8(68.12% and 42.03%) were significantly higher than those in puerperal with S/D value <2.8(19.61% and 13.73%), respectively(P<0. 01). The premature,SGA,PI,RI,SD and area under the ROC curve were gradually decreased in observation group. Conclusions:The high-frequency ultrasonic doppler of uterine artery can detect the hemodynamic parameters in high-risk pregnancy. The patient's condition can be determined by S/D value,which has certain clinic value.