超声检测下的子宫动脉血流变化在剖宫产后再次妊娠者中的临床意义  

Clinical significance of ultrasound-detected uterine artery flow changes in patients with recurrent pregnancies after cesarean delivery

作　　者：段静 Duan Jing(Department of Ultrasound,Shangqiu Central Hospital,Henan 476000,China)

机构地区：[1]河南省商丘市中心医院超声科,476000

出　　处：《实用医学影像杂志》2023年第5期360-363,共4页Journal of Practical Medical Imaging

摘　　要：目的探讨超声检测下的子宫动脉血流变化在剖宫产后再次妊娠患者中的临床意义。方法选取我院2021年1月至2022年2月期间收治的剖宫产后再次妊娠患者165例作为研究对象,以术后病理作为金标准,分析超声检测的诊断价值以及子宫动脉血流变化[子宫动脉处阻力指数(RI)、搏动指数(PI)以及收缩期峰值流速/舒张期流速(S/D)]的临床意义。结果165例剖宫产后再次妊娠患者中瘢痕妊娠阳性79例,阴性86例;超声诊断灵敏度、特异度、准确度、阳性预测值以及阴性预测值分别为87.34%、93.02%、90.30%、92.00%、88.89%;超声分型检出率为89.87%(71/79),Kappa指数为0.785[95%CI:(0.643~0.861),P<0.001];妊娠患者RI、PI、S/D对比,非瘢痕妊娠<部分突入型<完全突入型<混合团块型(P<0.001);不良妊娠结局患者RI、PI、S/D高于正常妊娠结局患者(P<0.001);受试者工作特征曲线(ROC)曲线显示,RI、PI、S/D联合预测不良妊娠结局AUC为0.893,最佳诊断灵敏度、特异度为95.00%、79.66%(P<0.001)。结论超声可辨别剖宫产子宫瘢痕妊娠患者类型,且不同分型患者血流变化存在差异,联合应用时可有效预测妊娠结局。Objective To investigate the clinical significance of ultrasound-detected changes in uterine artery blood flow in patients with a second pregnancy after cesarean delivery.Methods A total of 165 patients with second pregnancy after cesarean section admitted to our hospital from January 2021 to February 2022 were selected as research objects.Postoperative pathology was used as the gold standard.To analyze the diagnostic value of ultrasonic detection and the clinical significance of the changes of uterine artery blood flow,such as resistance index(RI),pulsation index(PI)and peak systolic flow velocity/diastolic flow velocity(S/D).Results Among 165 patients with second pregnancy after cesarean section,79 were positive and 86 were negative.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ultrasonic diagnosis were 87.34%,93.02%,90.30%,92.00%and 88.89%,respectively.The detection rate of ultrasonic typing was 89.87%(71/79),Kappa index was 0.785[95%CI:(0.643~0.861),P<0.001].The comparison of RI,PI and S/D in pregnant patients showed that non-cicatricial pregnancy<partial intrusion type<complete intrusion type<mixed mass type(P<0.001);RI,PI and S/D in patients with adverse pregnancy outcome were higher than those in patients with normal pregnancy outcome(P<0.001).The ROC curve showed that the combined RI,PI,and S/D predicted adverse pregnancy outcomes with an AUC of 0.893 and an optimal diagnostic sensitivity and specificity of 95.00%and 79.66%(P<0.001).Conclusion Ultrasonography can distinguish the types of caesarean section pregnancy patients with uterine scar,and the blood flow changes of dif-ferent types of patients are different,combined application can effectively predict the outcome of pregnancy.

关 键 词：超声检查 妊娠结局 瘢痕妊娠 诊断价值 终止妊娠 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.2[医药卫生—诊断学]