脐动脉舒张末期血流缺如的胎儿血液动力学变化与围产儿结局的关系  

Central and peripheral hemodynamic changes in fetuses with absent end-diastolic velocity in umbilical artery and the correlation with perinatal outcomes

作　　者：徐红兵[1] 曹珍修[1] 吴味辛[1] 

机构地区：[1]重庆医科大学附属第一医院妇产科,400016

出　　处：《中华围产医学杂志》2005年第2期92-96,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的应用彩色多普勒超声研究脐动脉舒张末期血流缺如(absent end-diastolic veloci-ty,AEDV)的胎儿心脏和外周血液动力学的变化,并与胎心率电子监护相比较,了解两者间的关系及围产儿结局.方法应用彩色多普勒超声技术对27例AEDV胎儿心脏水平(主动脉、肺动脉)和外周血管(脐动脉、大脑中动脉)的最大血流速度波形进行分析,与胎心率电子监护结合,随访围产儿预后.结果27例均表现肺动脉明显收缩,其流速积分(VTI)×胎心率(FHR)和右心输出量明显下降.27例中22例进行动态观测的病例中10例仅有大脑中动脉搏动指数(MCA PI)下降而没有左心输出量的明显改变;12例有MCA PI先降低,后上升两阶段改变,最后伴有主动脉VTI×FHR、左心输出量的显著减少.发现AEDV和出现胎心率异常的间隔时间是2～17 d.结论胎儿缺氧时脐血流AEDV可能早于胎心监护异常,AEDV一旦诊断应立即终止妊娠,如出现MCA PI升高或左心输出量的显著减少后终止妊娠,围产儿的病率和死亡率可能明显升高.Objective To investigate the relationship between absent end-diastolic velocity of fetal umbilical artery (AEDV) and perinatal outcome. Methods The color Doppler ultrasound result of maximum flow velocity waveforms at the cardiac level (aorta, pulmonary artery) and the peripheral level (fetal umbilical artery, middle cerebral artery) in 27 cases with Umbilical artery AEDV were analyzed. Fetal heart rate monitoring was performed and perinatal outcome was followed up. Results All of the 27 cases presented with remarkable pulmonary artery contraction. The result of velocity time integral (VTI)×fetal heart rate (FHR) and right cardiac output declined significantly. Among 22 cases with continuous monitoring, 10 cases showed reduced PI of middle cerebral artery (MCA) without changes of left cardiac output; 12 cases had biphasic changes of the MCA PI which consisted of decrease followed by increase and showed significant reduction of VTI×FHR of aorta and left car-(diac) output. The interval between the first detection of AEDV and the presentation of abnormal FHR patterns was 2 to 7 days. Conclusions Umbilical artery AEDV usually precedes the presentation of abnormal FHR under fetal hypoxia. Delivery before decompensation may improve the perinatal morbidity and mortality.

关 键 词：脐动脉舒张末期 围产儿结局 血液动力学变化 缺如 胎心率电子监护 彩色多普勒超声技术 左心输出量 AEDV 血流速度波形 动脉搏动指数 胎心监护异常 胎儿心脏 终止妊娠 大脑中动脉 围产儿预后 胎心率异常 超声研究 方法应用 

分 类 号：R714.5[医药卫生—妇产科学]