胎儿彩超监测联合胎心监护预测胎儿宫内窘迫的价值  

The value of fetal color Doppler ultrasonography combined with fetal heart rate monitoring in predicting fetal distress

作　　者：柳学芳[1] 刘卫民[1] 何艳[1] 蒲玉华 王小华[1] 邓丽霞 郑莉 LIU Xue-Fang;LIU Wei-Min;HE Yan(Department of Obstetrics and Gynecology,Qianjiang Central Hospital,Qianjiang,Hubei 433100,China)

机构地区：[1]潜江市中心医院妇产科,湖北潜江433100

出　　处：《中国妇幼保健》2018年第21期5005-5007,共3页Maternal and Child Health Care of China

基　　金：湖北省卫生和计划生育委员会2016-2017年疾病和医药院校科研专项立项项目(WJ2016-Y-46)

摘　　要：目的探讨胎儿彩超监测联合胎心监护预测胎儿宫内窘迫的价值。方法选取于2016年1月-2017年1月潜江市中心医院收治的符合纳入标准的妊娠晚期孕妇512例,均进行胎儿彩超检查及胎心监护,其中根据病史、症状以及分娩结局诊断为胎儿宫内窘迫患者145例为观察组,367例正常妊娠者为对照组。比较两组孕妇的大脑中动脉、脐动脉的血流动力学以及两种监测手段的临床符合率。观察组中145例胎儿宫内窘迫患儿采用胎儿彩超联合胎心监护,分为3组:(1)高危组:收缩期峰值流速与舒张末期血流速度的比值(S/D)比值≥2. 5,胎心监护异常;(2)S/D比值增高组:S/D比值≥2. 5,胎心监护正常;(3)胎心异常组:S/D比值正常,胎心监护异常。结果观察组胎儿大脑中动脉的血流动力学数值S/D、阻力指数(RI)及动脉搏动指数(PI)均明显低于对照组,脐动脉的血流动力学数值(S/D、RI及PI)均明显高于对照组,大脑中动脉/脐动脉的血流动力学数值(S/D、RI及PI)均明显低于对照组,差异有统计学意义(P<0. 05)。高危组羊水粪染、新生儿窒息的发生率均显著高于其他3组,Apgar评分显著低于其他3组,差异有统计学意义(P<0. 05); S/D比值增高组及胎心异常组羊水粪染、新生儿窒息的发生率均显著高于对照组,Apgar评分显著低于对照组,差异有统计学意义(P<0. 05); S/D比值增高组及胎心异常组之间Apgar评分比较,差异无统计学意义(P>0. 05)。结论通过采取联合胎心监护和胎儿彩超进行胎儿宫内窘迫的诊断,能够取长补短,提升临床诊断的准确性,减少新生儿的并发症,降低死亡率及剖宫产率。Objective To investigate the value of fetal color Doppler uhrasonography combined with fetal heart rate monitoring in predicting fetal distress. Methods In accordance with the inclusion criteria in our hospital, 512 cases of pregnant women in late pregnancy were selected in January 2016- January 2017. Fetal ultrasound examination and fetal heart rate monitoring were performed. According to the history, symptoms, diagnosis and outcome of delivery, 145 cases diagnosed as fetal distress were selected into the study group, 367 cases of normal pregnancy were selected into the control group . The hemodynamics of the middle cerebral artery and umbilical artery in two groups and the clinical coincidence rate of the two monitoring methods were compared. Results Numerical study on hemodynamics in the fetal brain artery group （S/D, RI, PI） were significantly lower than those of the control group, umbilical artery bemodynamic values （S/D, RI, PI） were significantly higher than those of the control group, the hemodynamies of umbilical artery, middle cerebral artery / numerical （ S/D, RI, PI） were significantly lower than those the control group, the differences were statistically significant （ P〈0. 01 ） . The high-risk group of meconium stained amniotic fluid and neonatal asphyxia were significantly higher than those of the other three groups, Apgar score was sig- nificantly lower than that of the other three groups, the differences were statistically significant （P〈0.01） ; meconium stained amniotie fluid and neonatal asphyxia of the ratio of S/D group increased and abnormal fetal heart group were significantly higher than those of the control group, Apgar score was significantly lower than that of the control group, the difference was statistically significant （ P〈0. 01 ） ; there was no significant difference in Apgar score between S/D ratio increased and abnormal fetal heart groups （ P〉0. 05 ） . Conclusion Combinated di- agnosis fetal heart monitoring and fetal color Doppler ultrasound fo

关 键 词：胎儿彩超 胎心监护 胎儿宫内窘迫 妊娠结局 

分 类 号：R445.1[医药卫生—影像医学与核医学]