中孕期静脉导管多普勒血流参数在预测胎儿生长受限中的应用研究  

Application of Doppler flow parameters of the ductus venosus in fetus during the second trimester in evaluating the prognosis of fetal growth restriction

作　　者：姜纬[1,2] 邓学东[1,2] 章茜[1,3] 陆伟[1,2] 

机构地区：[1]南京医科大学附属苏州医院 [2]苏州市立医院超声中心,江苏苏州215002 [3]苏州市立医院妇产科,江苏苏州215002

出　　处：《医学影像学杂志》2015年第2期308-312,共5页Journal of Medical Imaging

摘　　要：目的探讨中孕期静脉导管多普勒血流参数在预测胎儿生长受限中的应用价值。方法搜集我院产前检查的正常中孕期胎儿422例作为对照组;临床诊断为宫内生长受限的中孕期胎儿200例为研究组,分别测量两组胎儿静脉导管多普勒血流参数。以对照组静脉导管血流参数范围为正常参考值,结合脐动脉血流频谱表现,将研究组胎儿进行分组分析,并随访至妊娠结束,记录妊娠结局。结果对照组422例正常中孕期胎儿静脉导管血流参数:S波流速:(59.02±16.32)cm/s;A谷流速:(32.87±11.27)cm/s;RI:0.45±0.09;PI:0.53±0.13;S/D:1.87±0.34。研究组200例FGR分为5组:1研究一组14例,胎儿静脉导管血流参数S波流速较对照组减低,两组间差异无统计学意义(P>0.05),A谷流速较对照组减低,RI、PI和S/D值较对照组增高(P<0.05,两组间差异有统计学意义);2研究二组16例,胎儿静脉导管血流参数S波流速和A谷流速较对照组减低,而RI、PI和S/D值较对照组增高(P<0.05),两组间差异有统计学意义)。脐动脉血流舒张期缺如或脐动脉RI/大脑中动脉RI>1.0;3研究三组9例,静脉导管A谷血流消失或出现反流,且脐动脉血流舒张期缺如或反流,其中7例经临床诊断为不良妊娠而引产,另2例为双胎输血综合征中的供血儿,供血儿死亡后受血儿均妊娠至足月后分娩正常体重儿;4研究四组29例,胎儿表现为脐动脉血流频谱异常,而静脉导管血流频谱正常;5研究五组132例,胎儿静脉导管和脐动脉血流频谱均表现正常。结论中孕期FGR胎儿静脉导管多普勒血流频谱可反映胎儿宫内血氧及右心功能情况;当胎儿静脉导管多普勒血流频谱出现A谷血流消失或反流,且伴有脐动脉血流舒张期缺如或反流时,预示胎儿妊娠结局不良可能;静脉导管多普勒血流参数可作为预测FGR胎儿完好生存率的重要指标之一。Objective To investigate the clinical application of Doppler flow parameters of the ductus venosus in fetus during the second trimester in evaluating the prognosis of fetal growth restriction.Methods There were a control group（422 normal fetuses）and a study group（200 fetuses with FGR）.We measured and analyzed Doppler flow parameters of the ductus venosus in fetuses of the two groups,and the ultrasound findings were observed and recorded.We measured Doppler flow parameter RI of the umbilical artery and the middle cerebral artery in fetuses of the study group.200 fetuses were grouped into five groups according to Doppler flow parameters of the ductus venosus and the umbilical artery refer to the control group.Doppler flow parameters of the ductus venosus and the the umbilical artery and the ultrasound findings were analysed in each group.All these fetuses were followed up until the end of pregnancy and the pregnancy outcomes were recorded.Results Doppler flow parameters of the ductus venosus in 422 normal fetuses in control group were measured：Peak S：（59.02±16.32）cm/s,wave A：（32.87±11.27）cm/s,RI：0.45±0.09,PI：0.53±0.13,and S/D：1.87±0.34.200 fetuses in study group were divided into five groups based on Doppler flow parameters of the ductus venosus and the umbilical artery ①14 cases appeared as Peak S was lower than that in control group（P〉0.05）,and wave D was lower but RI,PI and S/D were higher than that in control group（P〈0.05）;② 16 fetuses appeared as Peak S and wave D were lower but RI,PI and S/D were higher than that in control group（P〈0.05）.The umbilical artery was absent enddiastolic flow or RI of the umbilical artery and RI of the middle cerebral artery ratio greater than 1.0;③ 9 cases appeared with absent or reversed wave A and the umbilical artery was absent or reversed end-diastolic flow.Among them,7fetuses there induced labor,and others were donor-twins of TTTS,whose donor-twins were dead and the recipient-twins were delivered at term with normal wei

关 键 词：中孕期 静脉导管 超声多普勒 胎儿生长受限 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]