妊娠中晚期子宫-胎盘-胎儿循环与妊娠期高血压疾病进展程度的相关研究  

The relationship of uterine-placenta-fetal circulation and the development of hypertensive disorders complicating pregnancy in the second- and third-trimester

作　　者：李晓菲[1] 吴青青[1] 王琪[1] 于松[1] 王莉[1] 高凤云[1] 安园园[1] 

机构地区：[1]首都医科大学附属北京妇产医院,100026

出　　处：《中国妇产科临床杂志》2013年第2期123-127,共5页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：教育部留学回国人员科研启动基金(教外司留[2005]383号)

摘　　要：目的探讨妊娠中晚期双侧子宫动脉血流阻力参数值、双侧子宫动脉舒张早期切迹及胎盘血管显示用于监测妊娠期高血压疾病进展程度的作用,寻找异常频谱界值并分析其与围生结局的关系。方法将71例妊娠期高血压疾病孕妇分为妊娠期高血压组(妊高组)、轻度子痫前期(pre-eclampsia,PE)组(轻度PE组)、重度子痫前期组(重度PE组)和妊娠合并慢性高血压病组(慢高组);39例无合并症单胎孕妇设为对照组。采用彩色超声检测各组孕妇双侧子宫动脉血流频谱,同时采用eFlow技术获得胎盘血流灌注图像,分析妊娠中晚期双侧子宫动脉血流阻力参数值、双侧子宫动脉舒张早期切迹、胎盘血管显示情况及异常频谱界值与围生期结局的关系。结果①与对照组、妊高组比较,重度PE组血流阻力参数值明显增高(P均<0.05),轻度PE组部分血流阻力参数值较对照组增高(P<0.05);以搏动指数(PI)平均值>0.825作为界值,预测重度子痫前期的灵敏度为81.1%,特异度为64.4%;②轻度PE组及重度PE组妊娠中晚期舒张早期切迹及双侧切迹存在率均较对照组、妊高组及慢高组高(P均<0.001);③以PI平均值>0.825和/或存在舒张早期切迹作为异常子宫动脉频谱界值,异常频谱组新生儿出生孕周及出生体质量明显小于正常频谱组(P均<0.001),异常频谱组由于血压控制不理想需行剖宫产终止妊娠,发生严重围生期并发症、死胎等严重不良围生期结局的发生率明显高于正常频谱组(P<0.001);④前壁胎盘孕妇中,子痫前期组患者三级绒毛动脉计数明显少于非子痫前期患者(P<0.05);后壁胎盘孕妇中,子痫前期组患者胎盘三级绒毛动脉显示率明显低于非子痫前期患者(P<0.05)。结论①妊娠中晚期双侧子宫动脉各血流阻力参数值及舒张早期切迹可用于预测子痫前期尤其是重度子痫前期的发生,可作为妊娠期高血压疾病严重程度的监测指标;②异Objective To explore the value of uterine artery Doppler resistant values, Doppler waveform and placenta vessel demonstration to monitor the development of hypertensive disorders complicating pregnant in the second- and third- trimester, and to find out the cut- off values of abnormal Doppler and analyze the relationship between these values and perinatal outcomes. Methods All pregnant women were divided into gestational hypertension group, mild pre- eclampsia group, severe pre- eclampsia group, chronic hypertension complicating pregnancy group and control group. Bilateral uterine artery Doppler was obtained, and the perfusion images of placenta were acquired by eFlow technique at the mean time. The resistant values, early - diastolic notch of bilateral uterine artery, placenta perfusion images and cut- off values of abnormal Doppler were detected, the relationship of these values and perinatal outcomes was analyzed. Results ① Compared with control group and gestational hypertension group, resistant value was apparently high in severe pre- eclampsia group （P〈0.05）, some resistant values ofmild pre- eclampsia group were higher than that of control group; Using mean PI〉0. 825 as cut- off to predict se- vere pre- eclampsia, the sensitivity was 81.1% and the specificity was 64. 4%. ② The existence of early- diastolic notch or bilateral early - diastolic notch was relatively high in mild and severe pre - eelampsia group compared to con- trol, gestational hypertension and ehronie hypertension complieating pregnancy group （P〈0. 001）. ③ Using mean PI 〉0. 825 and existence of early- diastolic notch to define the abnormal uterine artery Doppler, fetal birth week and birth weight of abnormal Doppler group was apparently lower than that in normal Doppler group （P〈0. 001）, and severe abnormal perinatal outcomes, for example, the caesarean rate because of bad control of blood pressure, severe perinatal complications, fetal perinatal death, et al, was higher in abnormal Doppler group than in normal D

关 键 词：子宫-胎盘-胎儿循环 妊娠期高血压疾病 子宫动脉频谱 胎盘血流灌注 围生期结局 

分 类 号：R714.2[医药卫生—妇产科学]