脐带高螺旋的超声预警系统建立及临床分析  

Analysis of Ultrasonic Warning System in Hyper-Coiling Umbilical Cord

作　　者：解珺淑[1] 闫亚妮[1] 杨振娟[1] 李云桃[1] 薛小伟 张晓红[1] 裴秋艳[1] Xie Junshu;Yan Yani;Yang Zhenjuan;Li Yuntao;Xue Xiaowei;Zhang Xiaohong;Pei Qiuyan(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing 10004,China)

机构地区：[1]北京大学人民医院妇产科,北京市100044

出　　处：《中国超声医学杂志》2024年第8期913-916,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的建立脐带高螺旋(HC)时影响妊娠结局的超声预警系统。方法回顾性分析29例HC患者超声特征,并根据是否合并高危因素(①膀胱两侧脐动脉高阻力;②胎儿生长受限(FGR);③大脑中动脉舒张期峰值流速增快;④羊水过少;脑实质回声增强;③静脉导管A波反向)分为复杂型与单纯型两类,根据分娩情况分为引产组、干预组及非干预组,通过高危因素在各组的分布情况,建立HC超声预警系统。结果单纯型HC9例,复杂型HC20例,复杂型HC患者干预比例高(P=0.027)、分娩孕周早(P=0.034)、胎心监护异常比例高(P=0.027)、剖宫产比例高(P=0.005)。引产组平均脐带螺旋指数(UCI)与干预组和非干预组相比差异存在统计学意义(P<0.001)。引产组、干预组、非干预组3组相比,在高危因素个数及6项高危因素分布比例方面差异均存在统计学意义(P<0.001)。结论通过超声对于6项高危因素的监测,复杂型HC患者需要引起临床警戒。膀胱两侧脐动脉高阻力和FGR是出现较早的预警指征。Objectivee To establish an ultrasonic warning system for clinical intervention in patients with the hyper-coiling umbilical cord(HC).Methods We retrospectively analyzed the ultrasonic characteristics of 29 patients diagnosed with HC.The high-risk factors were defined as ①High resistance of umbilical arteries beside the bladder,②fetal growth restriction(FGR),③increased peak diastolic velocity of middle cerebral artery,④oligohydramnios,⑤enhanced echo of the cerebral parenchyma,⑥reversed A wave of the ductus venous.According to the presence of these high-risk factors,they were divided into the complex type and the simple type,and further divided according to the delivery situation into to the terminated pregnancy group,the intervention group,and the non-intervention group.We tried to established an ultrasonic early warning system according to the distribution of high-risk factors in each group.Results Compared with 9 cases in the simple HC group and 20 cases in the complex HC group,the intervention ratio of complex HC patients was higher(P=0.027).Besides,the average delivery gestational weeks was smaller(P=0.034),and the abnormal rate of fetal heart monitoring was higher(P=0.027)in the complex HC group.The average umbilical coiling index(UCI)of the terminated pregnancy group was statistically different from the intervention and non-intervention groups(P<0.001).There were statistically significant differences in the number of high-risk factors and the distribution proportion of six high-risk factors among the three groups(P<0.001).Conclusions The monitoring of six high-risk factors by ultrasound is necessary for complex HC patients.High resistance of umbilical arteries beside the bladder and FGR are the earliest warning signs.

关 键 词：脐带高螺旋 脐动脉血流频谱 胎儿生长受限 临床预警系统 脐带螺旋指数 

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]