妊娠晚期孕妇体位对彩色多普勒超声检测胎儿脐动脉和大脑中动脉血流影响  

The Influence of Positions of Pregnant Women in Late Pregnancy on Determination of Hemodynamics of Fetal Umbilical Artery and Middle Cerebral Artery by Doppler Ultrasound

作　　者：陈树寰 吴育杰 刘春荣 林秀荣 王桂 CHEN Shu-huan;WU Yu-jie;LIU Chun-rong;LIN Xiu-rong;WANG Gui(Department of Electrocardiography and Ultrasonics,the People's Hospital of Tunchang County,Tunchang,Hainan 571600,China)

机构地区：[1]屯昌县人民医院心电超声科,海南屯昌571600

出　　处：《临床误诊误治》2018年第8期27-31,共5页Clinical Misdiagnosis & Mistherapy

基　　金：海南省卫计委基金资助项目(20170895A)

摘　　要：目的探讨妊娠晚期孕妇体位对彩色多普勒超声检测胎儿脐动脉和大脑中动脉血流影响及彩色多普勒超声检测预测胎儿宫内缺氧价值。方法应用彩色多普勒超声检测67例妊娠晚期孕妇仰卧位、左侧卧位及右侧卧位胎儿脐动脉和大脑中动脉血流动力学参数[收缩期峰值(PSV)、舒张期末最大血流速度(EDV)、阻力指数(RI)、搏动指数(PI)、PSV与EDV之比(S/D)],比较各体位时参数变化,并与胎儿出生后1 min Apgar评分结果作比较,评估彩色多普勒超声检测预测胎儿宫内缺氧的价值。结果妊娠晚期孕妇不同体位时胎儿脐动脉血流动力学参数比较,仰卧位PSV、RI和PI均高于左、右侧卧位,EDV均低于左、右侧卧位,S/D高于右侧卧位,差异有统计学意义(P<0.01);左侧卧位EDV高于右侧卧位,差异有统计学意义(P<0.01)。妊娠晚期孕妇不同体位时胎儿大脑中动脉血流动力学参数比较,左侧卧位RI和PI均低于右侧卧位,差异有统计学意义(P<0.01);仰卧位PSV、RI、PI和S/D均高于左、右侧卧位,EDV均低于左、右侧卧位,差异有统计学意义(P<0.01)。本组新生儿出生后1 min Apgar评分8~10分者61例,4~8分者6例;仰卧位与左、右侧卧位时彩色多普勒超声检测胎儿大脑中动脉与脐动脉RI比值均>1,轻度窒息6例均未能在彩色多普勒超声检测中被预测。结论妊娠晚期孕妇不同体位对彩色多普勒超声检测胎儿脐动脉和大脑中动脉血流动力学参数有明显影响,胎儿脐动脉和大脑中动脉血流动力学参数难以预测新生儿轻度窒息。Objective To investigate whether positions of pregnant women in late pregnancy can influence the determination of hemodynamics of fetal umbilical artery(UA)and middle cerebral artery(MCA)evaluated by Doppler ultrasound and its value in the prediction of fetal hypoxia.Methods Pulsed wave Doppler was used for the evaluation of hemodynamics of fetal UA and MCA in 67 women with third trimester pregnancy who were kept in left lateral decubitus position,right lateral decubitus position and supine position,respectively.Hemodynamic parameters including peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),pulsatility index(PI),and end systolic veloctity/end diastolic veloctity(S/D)of their fetal UA and MCA were determined and analyzed.Changes in parameters of those pregnant women with three alternative positions were recorded and compared with Apgar score at 1 min after birth.The value of color Doppler ultrasound in predicting fetal intrauterine hypoxia was evaluated.Results For hemodynamic parameters of fetal UA,PSV,RI and PI in supine position of pregnant women in late pregnancy were higher than those in left and right lateral decubitus position,and EDV was lower than that in left and right lateral decubitus position.Moreover,S/D was higher than that in right lateral decubitus position,and the difference was statistically significant(P<0.01).EDV in left lateral decubitus position was higher than that in right lateral decubitus position,and the difference was statistically significant(P<0.01).As for parameters in fetal MCA,RI and PI in the left lateral decubitus position were lower than those in the right lateral decubitus position and there were significant differences(P<0.01).PSV,RI,PI and S/D were higher and EDV was lower in the supine position,as compared with those in the left and right lateral decubitus position,and significant differences were noted(P<0.01).Apgar scores at 1 min after birth in this group were 8-10 points in 61 cases and 4-8 points in 6.Color Doppler ultrasound showed that t

关 键 词：孕妇 体位 超声检查 多普勒 彩色 脐动脉 大脑中动脉 血流动力学 胎儿缺氧 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]