产前胎儿脐动脉大脑中动脉及肾动脉血流动力学参数对羊水过少胎儿结局的预测价值  

Predictive value of antenatal fetal umbilical artery,middle cerebral artery,renal artery hemodynamic parameters on the fetal outcome of oligohydramnios

作　　者：林蓓蕾 徐晨阳 LIN Bei-lei;XU Chen-yang(Wenzhou Central Hospital,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市中心医院,浙江温州325000

出　　处：《中国妇幼保健》2023年第10期1921-1925,共5页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2020KY921)。

摘　　要：目的分析胎儿脐动脉(UA)、大脑中动脉(MCA)及肾动脉(RA)的血流动力学参数对于羊水过少胎儿结局的预测价值。方法选取2019年6月—2021年2月在温州市中心医院分娩的妊娠晚期合并羊水过少产妇106例为羊水过少组,并根据分娩结局分为胎儿窘迫组(35例)和无窘迫组(71例)。另选取同期在该院分娩的羊水量正常产妇106例为对照组,采用彩色多普勒超声诊断仪获取各组胎儿UA、MCA及RA的收缩期峰值流速与舒张期血流速的比值(S/D)、搏动指数(PI)及阻力指数(RI);计算UA与MCA血流动力学参数(S/D、RI及PI)比值,RA与MCA血流动力学参数(S/D、RI及PI)比值。采用ROC曲线分析胎儿UA、MCA及RA的血流动力学参数S/D、RI及PI,UA与MCA血流动力学参数(S/D、RI及PI)比值,RA与MCA血流动力学参数(S/D、RI及PI)比值对胎儿窘迫的预测价值。结果羊水过少组UA的S/D、PI及RI均高于对照组,MCA的S/D、PI及RI均低于对照组,RA的S/D、PI及RI均高于对照组,差异均有统计学意义(均P<0.05)。胎儿窘迫组UA的S/D、PI及RI均高于无窘迫组,MCA的S/D、PI及RI均低于无窘迫组,RA的S/D、PI及RI均高于无窘迫组,差异均有统计学意义(均P<0.05)。胎儿窘迫组UA/MCA和RA/MCA的S/D、PI及RI比值均高于无窘迫组,差异均有统计学意义(均P<0.05)。当胎儿UA的S/D>2.685、RI>0.723、PI>1.116时,预测羊水过少产妇胎儿窘迫的特异度、灵敏度为77.1%、94.4%;当胎儿MCA的S/D<3.277、RI<0.643及PI<1.410时,预测胎儿窘迫的特异度、灵敏度为82.9%、87.3%;当胎儿RA的S/D>4.421、RI>0.888及PI>1.785时,预测胎儿窘迫的特异度、灵敏度为82.9%、85.9%;当S/D(UA/MCA)>0.740、RI(UA/MCA)>0.865及PI(UA/MCA)>0.765时,预测羊水过少者胎儿窘迫的特异度、灵敏度为95.8%、85.7%;当S/D(RA/MCA)>1.610、RI(RA/MCA)>1.170及PI(RA/MCA)>1.405时,预测胎儿窘迫的特异度、灵敏度为93.0%、82.9%。结论UA/MCA、RA/MCA血流动力学参数比值预测羊水过少者胎�Objective To analyze the predictive value of hemodynamic parameters of fetal umbilical artery(UA),middle cerebral ar⁃tery(MCA)and renal artery(RA)for the outcome of oligohydramnios fetuses.Methods A total of 106 cases of late pregnancy with oligo⁃hydramnios who gave birth in our hospital were selected as the oligohydramnios group,and were divided into fetal distress group(35 cases)and non-distress group(71 cases)according to the delivery outcome.In addition,106 parturients with normal amniotic fluid volume during delivery were selected as the control group.The ratio of peak systolic flow rate to diastolic blood flow rate(S/D),pulsatility index(PI)and resist⁃ance index(RI)of fetal UA,MCA,and RA of fetal were obtained with color Doppler ultrasound diagnostic apparatus;the ratios of UA and MCA hemodynamic parameters(S/D,RI and PI),and the ratios of RA and MCA hemodynamic parameters(S/D,RI and PI)were calcu⁃lated.The predictive value of the hemodynamic parameters S/D,RI and PI of fetal UA,MCA,RA,the ratios of UA and MCA hemodynamic parameters(S/D,RI and PI),the ratios of RA and MCA hemodynamic parameters(S/D,RI and PI)were analyzed with ROC curve.Results The S/D,PI and RI of UA and RA in the oligohydramnios group were higher than those in the control group,while the S/D,PI and RI of MCA were lower than those in the control group(P<0.05).The S/D,PI,RI of UA and RA,the S/D,PI and RI ratios of UA/MCA and RA/MCA in the fetal distress group were all higher than those in the non-distress group,and the S/D,PI,RI of MCA were lower than those in the non-distress group(P<0.05).When fetal UA S/D>2.685,RI>0.723,PI>1.116,the specificity and sensi⁃tivity of predicting fetal distress in oligohydramnios were 77.1%and 94.4%;when fetal MCA S/D<3.277,RI<0.643,PI<1.410,the spe⁃cificity and sensitivity of predicting fetal distress were 82.9%and 87.3%;when fetal RA S/D>4.421,RI>0.888,PI>1.785,the specifici⁃ty and sensitivity of predicting fetal distress were 82.9%and 85.9%;when S/D(UA/MCA)>0.740,RI(UA/MCA)>0.865,PI(UA/MCA)>0

关 键 词：脐动脉 大脑中动脉 肾动脉 羊水过少 胎儿窘迫 

分 类 号：R714.2[医药卫生—妇产科学]