脐动脉和大脑中动脉血流频谱诊断胎儿宫内缺氧的价值分析  

Study on value of blood flow spectrum of umbilical artery and middle cerebral artery in diagnosis of intrauterine hypoxia

作　　者：王晓影 刘奇[1] Wang Xiaoying;Liu Qi(Department of Ultrasound,The First Hospital of Beijing Fangshan,Beijing 102400,China)

机构地区：[1]北京市房山区第一医院超声科,102400

出　　处：《北京医学》2020年第12期1206-1209,共4页Beijing Medical Journal

摘　　要：目的探讨脐动脉(umbilical artery,UA)和大脑中动脉(middle cerebral artery,MCA)血流频谱诊断胎儿宫内缺氧的价值。方法选取2017年1月至2019年8月北京市房山区第一医院住院分娩的孕妇200例,其中62例胎儿宫内缺氧孕妇为研究组,138例正常妊娠孕妇为对照组。采用彩色多普勒超声检测胎儿UA、MCA的血流频谱,记录血流搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、收缩期与舒张期流速比(systolic to diastolic velocity ratio,S/D);采用logistic回归、ROC曲线分析胎儿UA、MCA的血流频谱对胎儿宫内缺氧的诊断价值。结果研究组UA的PI、RI、S/D明显高于对照组(P<0.05),MCA、MCA/UA的PI、RI、S/D明显低于对照组(P<0.05)。Logistic多因素回归分析显示,MCA/UA的PI、RI、S/D是胎儿宫内缺氧的独立影响因素(P<0.05)。ROC曲线得出,MCA/UA的PI、RI、S/D及联合检测诊断胎儿宫内缺氧的AUC分别为0.860、0.801、0.813、0.874,均可诊断胎儿宫内缺氧。PI、RI、S/D及联合检测的AUC两两比较,差异均无统计学意义(P>0.05)。在最佳临界值点对应的灵敏度、特异度分别是,PI为72.6%、89.9%,RI为90.3%、58.7%,S/D为100.0%、65.2%,联合检测为88.7%、86.2%。结论胎儿宫内缺氧时UA、MCA的PI、RI、S/D发生明显变化,MCA/UA的PI、RI、S/D对胎儿宫内缺氧具有较高的诊断价值,三者联合检测诊断价值更高。临床上可采用彩色多普勒超声进行产前检测,能有效检测出胎儿宫内缺氧并采取预防和治疗措施,对降低新生儿死亡率和畸形率有重要意义。Objective To explore the value of blood flow spectrum of umbilical artery(UA)and fetal middle cerebral artery(MCA)in diagnosing intrauterine hypoxia.Methods Two hundred pregnant women who were hospitalized and delivered in our hospital from January 2017 to August 2019 were selected as the research subject,of which 62 cases of intrauterine hypoxia were the study group,and 138 normal pregnant women were the control group.Blood flow spectrum of fetal UA,MCA were detected by color Doppler ultrasound,including blood pulsatility index(PI),resistance index(RI),systolic and diastolic flow velocity ratio(S/D).The diagnostic value of blood flow spectrum of UA and MCA in fetal hypoxia were evaluated by binary logistic regression and ROC curve.Results The PI,RI and S/D of the study group were significantly higher than those of the control group,the difference was statistically significant(P<0.05).The PI,RI and S/D of the MCA and MCA/UA of the study group were significantly lower than those of the control group,the difference was statistically significant(P<0.05).Binary logistic regression analysis showed that,the PI,RI and S/D of MCA/UA were independent influence factors of fetal hypoxia(P<0.05).The ROC curve showed that the PI,RI,S/D and parallel combined detection of MCA/UA AUC for the diagnosis of fetal hypoxia were 0.860,0.801,0.813,and 0.874.PI,RI,S/D and combined detection of AUC had no statistical significance(P>0.05).The corresponding sensitivity and specificity at the optimal critical point were:PI72.6%,89.9%;RI 90.3%,58.7%;S/D 100.0%,65.2%;joint detection 88.7%,86.2%.Conclusions The PI,RI,and S/D of UA and MCA change significantly when the fetus is hypoxic.The PI,RI,and S/D of MCA/UA have a high diagnostic value for fetal hypoxia.The combination of the three indicators has higher value for detect and diagnose.Clinically,color Doppler ultrasound can be used for prenatal testing,which can effectively detect fetal hypoxia to take preventive and therapeutic measures,which is of great significance for reducing neonatal

关 键 词：脐动脉 大脑中动脉 血流频谱 胎儿宫内缺氧 

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