彩色多普勒超声对脐带绕颈诊断结果易变性的研究  

Diagnostic Changeability of Color Doppler Flow Imaging for Detecting Nuchal Cord

作　　者：徐晓红[1] 李英勇[2] 刘锋[1] 罗桂香[2] 廖桂英[1] 

机构地区：[1]广东医学院附属医院超声科,广东省湛江市524001 [2]广东医学院附属医院妇产科,广东省湛江市524001

出　　处：《中国超声医学杂志》2005年第5期379-381,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的研究彩色多普勒血流显像(CDFI)对脐带绕颈的诊断价值和对分娩方式及对新生儿预后的影响。方法应用CDFI对389例疑脐带绕颈的晚期孕妇进行了检查,并对其脐动脉S/D比值进行了测定。结果(1)CDFI对脐带绕颈的诊断率与CDFI检查距分娩时间密切相关,分娩前1周内超声诊断率较2周及3周显著增高(P<0.01);(2)脐带绕颈组合并宫内窘迫者脐动脉收缩期/舒张期血流速度(S/D)比值(2.97±0.56)较无宫内窘迫者(2.32±0.47)显著增高(P<0.001);(3)经阴道分娩时,羊水中脐带呈直线状新生儿窒息发生率较羊水中脐带呈曲线状增高(P<0.01);(4)当脐动脉S/D值>3.0,且胎心率有改变或羊水中脐带呈直线状时,应及时行剖宫产结束分娩;(5)对晚期孕妇追踪结果显示脐带绕颈结果易变,与诸多因素有关,需追踪观察。结论CDFI对脐带绕颈的诊断率与CDFI检查距分娩时间密切相关;脐动脉S/D比值及羊水中脐带的曲直状态对预测胎儿宫内窘迫及分娩时新生儿窒息的发生率有较大的临床价值。可用来指导临床正确处理产程和及时选择合适的分娩方式。Objective To study the diagnostic value in cord entanglement,the influence on delivery form,and the prediction for neonatal prognosis by color Doppler flow imaging(CDFI).Methods A total of 389 late pregnant women suspected with umbilical cord around the neck were examined by CDFI,and the systolic/diastolic (S/D)ratio of umbilical artery was also detected.Results The diagnostic rate of CDFI for umbilical cord entanglement correlated with the interval between the CDFI and delivery.The accurate diagnosis rate was higher in 1 week before delivery than that in 2 to 3 weeks (P<0.01).S/D ratio in fetuses with nuchal cord and fetal distress was superior to that without fetal distress (2.97±0.56 vs 2.32±0.47,P<0.001).The prevalence of fetal distress significantly increased in fetuses with straight umbilical cords compared with that of tortuous cords in amniotic fluid at vaginal delivery(P<0.01).Cesarean section should be performed in time on those with S/D ratio >3,fetal heart rate change and straight umbilical cords.The diagnosis results of CDFI were changeable and ought to be followed up.Conclusions The diagnostic value of CDFI for nuchal cord correlates with the interval between the CDFI and delivery.S/D ratio and straight or tortuous umbilical cord are helpful in evaluating the prevalence of fetal distress and neonatal asphyxia.CDFI for late pregnant women suspected with nuchal cord provides a valuable reference for the management of birth process and the choice of parturition pattern.

关 键 词：脐带绕颈 彩色多普勒超声 诊断结果 易变性 彩色多普勒血流显像 CDFI检查 脐动脉S/D值 S/D比值 脐动脉收缩期 胎儿宫内窘迫 分娩方式 晚期孕妇 分娩时间 新生儿预后 超声诊断率 经阴道分娩 窒息发生率 新生儿窒息 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]