脐带绕颈松紧程度的定量分析及其对胎儿左心功能的影响  

Quantitative Analysis of the Degree of Tightness of Umbilical Cord Around the Neck and its Effect on Fetal Left Ventricular Function

作　　者：张力维[1] 谌雪 王义成[1] 杨瑞敏[1] 刘云春[3] 刘宏强[1] Zhang Liwei;Chen Xue;Wang Yicheng;Yang Ruimin;Liu Yunchun;Liu Hongqiang(Department of Ultrasound,the First Affiliated Hospital of Hebei North UniversityZhangjiakou,Hebei 075000,China;Department of Ultrasound,Huailai Hospital of Traditional Chinese Medicine,Huailai,Hebei 075400,China;Department of Obstetrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院超声医学科,河北省张家口市075000 [2]怀来县中医医院超声科,河北省张家口市075000 [3]河北北方学院附属第一医院产科,河北省怀来县075400

出　　处：《中国超声医学杂志》2021年第10期1129-1132,共4页Chinese Journal of Ultrasound in Medicine

基　　金：河北省2020年度医学科学研究课题计划(No.20200201)。

摘　　要：目的探讨脐带绕颈一周胎儿脐带绕颈的松紧程度及其对胎儿左心功能的影响,以及对预测胎儿宫内缺氧的价值。方法选取孕30~37^(+6)周脐带绕颈一周胎儿131例为研究对象,按脐带绕颈压迹深度分为:0.60 cm以下组(A组)、0.60~0.69 cm组(B组)、0.70~0.79 cm组(C组)、0.80 cm以上组(D组),选择同期周孕周无脐带绕颈胎儿157例为对照组。比较各组胎儿左心室射血分数(LVEF)、二尖瓣环Ea/Aa值及左心室Tei指数。另根据临床诊断标准将脐带绕颈胎儿分为缺氧组和正常组,比较两组胎儿上述各参数,并采用受试者工作特征(ROC)曲线评价各参数单独及联合诊断对预测胎儿宫内缺氧的价值。结果 A组、B组、C组及对照组各组间比较,胎儿LVEF、Ea/Aa值、Tei指数差异均无统计学意义(P>0.05);与A组、B组、C组及对照组比较,D组胎儿LVEF、Ea/Aa值减小,Tei指数增大,差异均有统计学意义(P<0.05)。与正常组比较,缺氧组胎儿LVEF、Ea/Aa值减小,Tei指数增大,差异均有统计学意义(P<0.05)。ROC曲线结果显示,上述各参数联合诊断的曲线下面积(AUC)较单独诊断的高(P<0.05)。结论脐带绕颈压迹深度可间接反映脐带绕颈一周胎儿宫内缺氧状态,为临床的早期干预及分娩时机的选择提供重要依据。Objective To investigate the degree of tightness of umbilical cord around the neck and its effect on fetal left ventricular function with umbilical cord around neck one loop, as well as its value in predicting fetal intrauterine hypoxia. Methods 131 fetuses with umbilical cord around the neck one loop at 30-37^(+6) weeks were selected as the research objects, according to the indentation depth, they were divided into A group(less than 0.60 cm), B group 0.60-0.69 cm, C group 0.70-0.79 cm and D group(more than 0.80 cm), 157 fetuses without umbilical cord around the neck at the same gestational week were selected as the control group. Left ventricular ejection fraction(LVEF), Ea/Aa value of mitral annulus and left ventricular Tei index were compared and analyzed in each group. According to the clinical diagnostic criteria, the fetuses with umbilical cord around the neck were divided into hypoxia group and normal group, and the above parameters were compared between the two groups. The receiver operating characteristic(ROC) curve was used to evaluate the value of each parameter alone or combined in predicting fetal intrauterine hypoxia. Results There were no significant difference in LVEF, Ea/Aa value and the Tei index among group A, group B, group C and control group(all P>0.05). The LVEF, Ea/Aa value of group D were significantly lower than those of the group A, group B, group C and control group(all P<0.05). The Tei index of group D was significantly higher than that of the group A, group B, group C and control group(P<0.05). The LVEF, Ea/Aa value of the hypoxia group were significantly lower than those of normal group(all P<0.05). The Tei index of hypoxia group was significantly higher than that of normal group(P<0.05). The ROC curve results showed that the area under curve(AUC) of the combined diagnosis of the above parameters was higher than that of the single diagnosis(P<0.05). Conclusions The depth of indentation around the neck of umbilical cord can indirectly evaluate the early intrauterine hypoxia of fetus

关 键 词：脐带绕颈 定量分析 胎儿 左心功能 宫内缺氧 

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]