超声观察晚孕期脐带绕颈胎儿脐血管血流的临床研究  

Ultrasound observation of blood flow inumbilical vessels of fetuses with nuchal cordin late pregnancy

作　　者：冯蕾[1] 王琼[1] 李焕菊 赵红岩 FENG Lei;WANG Qiong;LI Huan-ju;ZHAO Hong-yan(Department of Ultrasound,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Lishilu Clinic,Jingzhong Medical Campus of Chinese PLA General Hospital,Beijing 100045,China)

机构地区：[1]解放军总医院第四医学中心超声科,北京100048 [2]解放军总医院京中医疗区礼士路门诊部,北京100045

出　　处：《医疗卫生装备》2021年第11期51-54,91,共5页Chinese Medical Equipment Journal

摘　　要：目的:比较晚孕期脐带绕颈胎儿羊水内游离段脐动脉与绕颈段脐动脉的血流参数及脐血管走行情况,观察颈后压迹深度与绕颈段脐动脉血流参数的相关性,以期为临床诊断胎儿是否存在宫内缺氧提供依据。方法:回顾性分析2019年2—9月及2021年2月在某院就诊的38例存在胎儿脐带绕颈1周的晚孕期孕妇的临床资料,比较其游离段脐动脉与绕颈段脐带动脉的收缩期最大血流速度(peak systolic velocity,PSV)、舒张末期血流速度(end diastolic velocity,EDV)、平均血流速度(mean velocity,MV)、收缩期最大血流速度/舒张末期血流速度(peak systolic velocity/end diastolic velocity,S/D)、阻力指数(resistance index,RI)及搏动指数(pulsatility index,PI)等血流参数。采用Pearson相关性分析法验证胎儿颈后压迹深度与绕颈段脐动脉血流参数的相关性,并比较游离段脐血管与绕颈段脐血管的走行情况。采用SPSS 17.0软件进行统计学分析。结果:38例孕妇羊水内游离段脐动脉与绕颈段脐动脉的PSV、EDV、MV、RI和PI无统计学差异(P>0.05),游离段脐动脉S/D较绕颈段脐动脉高(P<0.05)。颈后压迹深度与绕颈段脐动脉S/D、RI及PI均无显著相关性(r值分别为0.11、0.11和0.09,P均>0.05)。绕颈段脐血管中走行直者(33例,占86.84%)多于游离段脐血管中走行直者(12例,占31.58%)。结论:晚孕期脐带绕颈胎儿宜同时选取其游离段脐带及绕颈段脐带测量脐动脉血流参数,有助于临床医生全面了解胎儿宫内情况,及时诊断是否存在胎儿宫内缺氧情况,降低围生期不良结局的发生率。Objective To compare the blood flow parameters and umbilical artery routing in the free segment in the amniotic fluid and the segment around the neck of the late pregnancy fetus and explore the correlation between the indentation depth of nuchal cord and the blood flow parameters of the segment around the neck in order to provide a basis for clinical diagnosis of intrauterine hypoxia in the fetus.Methods The clinical data of 38 late pregnant women with the umbilical cord wrapping around the baby's neck one times who were hospitalized from February to September 2019 and February 2021 were analyzed retrospectively.The blood flow parameters of the free segment in the amniotic fluid and the segment around the neck were compared including the peak systolic velocity(PSV),end diastolic velocity(EDV),mean velocity(MV),peak systolic velocity/end diastolic velocity(S/D),resistance index(RI)and pulsatility index(PI).Pearson correlation analysis was used to verify the correlation between the indentation depth of nuchal cord and the blood flow parameters of the segment around the neck and to compare the routing of the free segment and the segment around the neck.SPSS 17.0 was used for statistical analysis.Results There were no statistically significant differences in PSV,EDV,MV,RI and PI between the two segments(P>0.05),while the free segment had the S/D higher than that of the segment around the neck(P<0.05).The indentation depth of nuchal cord had no correlation with the S/D,RI and PI of the segment around the neck,with the values of r being 0.11,0.11 and 0.09 respectively(P>0.05).There were more segments around the neck(33 cases,86.84%)routed straightly than free ones(12 cases,31.58%).Conclusion In late pregnancy,it is advisable to measure umbilical artery flow parameters in both the free segment and the segment around the neck to help clinicians understand the intrauterine condition of the fetus,diagnose intrauterine hypoxia in a timely manner and reduce the incidence of adverse perinatal outcomes.

关 键 词：彩色多普勒超声 脐带绕颈 晚孕期 脐动脉血流参数 压迹深度 

分 类 号：R714.5[医药卫生—妇产科学]