四维超声联合脐血流超声参数对高危孕妇胎儿宫内缺氧的诊断价值  

Diagnostic value of four-dimensional ultrasound combined with umbilical artery ultrasound parameters for intrauterine hypoxia in high-risk pregnant women

作　　者：范淑玉 郭蜜甜 邢丽丽[1] 王雅娟 FAN Shu-yu;GUO Mi-tian;XING Li-li;WANG Ya-juan(Department of Ultrasound Imaging,the 7th People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA;Department of Obstetrics and Gynecology,the 7th People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州市第七人民医院超声影像科,河南郑州450000 [2]郑州市第七人民医院妇产科,河南郑州450000

出　　处：《海南医学》2025年第3期408-412,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20210757)。

摘　　要：目的探讨四维超声联合脐血流超声参数在高危孕妇胎儿宫内缺氧诊断中的应用价值。方法前瞻性选取2019年6月至2024年6月郑州市第七人民医院收治的110例拟分娩的高危孕妇作为研究对象,依据胎儿宫内缺氧发生情况分为缺氧组(n=42)和非缺氧组(n=68)。比较两组孕妇脐血流超声[脐动脉搏动指数(PI)、阻力指数(RI)、收缩期与舒张期流速比值(S/D)]、四维超声参数[心室收缩期峰值流速(S波值)、心房收缩期速度(A波值)、心室舒张期峰值流速(D波值)],采用受试者工作特征(ROC)曲线、列线图诊断模型、决策曲线分析法(DCA)分析四维超声及脐血流超声参数对高危孕妇胎儿宫内缺氧的诊断价值。基于ROC分析的结果构建高危孕妇胎儿宫内缺氧诊断模型并进行内部验证。结果缺氧组胎儿脐动脉PI、RI、S/D分别为1.34±0.22、0.78±0.13、3.82±0.33,均高于非缺氧组的1.19±0.20、0.70±0.10、3.53±0.28,差异均有统计学意义(P<0.05);缺氧组胎儿上腔静脉血流S波值及A波值分别为(57.69±3.46)cm/s、(26.10±2.16)cm/s,均高于非缺氧组的(52.46±4.10)cm/s、(23.65±1.68)cm/s,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,S/D、S波值、A波值诊断高危孕妇胎儿宫内缺氧的曲线下面积(AUC)为0.751(95%CI:0.651~0.851)、0.837(95%CI:0.762~0.912)、0.813(95%CI:0.728~0.898),有相对理想的诊断价值。基于AUC结果构建宫内缺氧风险列线图诊断模型,列线图的精确度和区分度良好;DCA曲线显示列线图诊断模型具有正向净获益。结论四维超声、脐血流超声参数能从不同角度诊断胎儿宫内缺氧,两者联合构建的诊断模型可准确诊断高危孕妇胎儿宫内缺氧情况。Objective To explore the application value of four-dimensional ultrasound combined with umbilical artery ultrasound parameters in the diagnosis of intrauterine hypoxia in high-risk pregnant women.Methods A total of 110 high-risk pregnant women scheduled to give birth in the 7th People's Hospital of Zhengzhou from June 2019 to June 2024 were prospectively selected and divided into an hypoxia group(n=42)and a non-hypoxia group(n=68)based on the occurrence of fetal intrauterine hypoxia.The two groups of pregnant women were compared in umbilical blood flow ultrasound(umbilical artery pulsation index[PI],resistance index[RI],systolic to diastolic velocity ratio[S/D]),four-dimension ultrasound parameters(peak ventricular systolic velocity[S wave value],atrial systolic velocity[A wave value],and peak ventricular diastolic velocity[D wave value]).Receiver operating characteristic(ROC)curve,nomogram diagnostic model,and decision curve analysis(DCA)were used to analyze the diagnostic value of four dimensional ultrasound and umbilical cord blood flow ultrasound parameters for fetal hypoxia in high-risk pregnant women.Based on the results of ROC analysis,a diagnostic model of fetal intrauterine hypoxia in high-risk pregnant women was constructed and internally verified.Results The PI,RI,and S/D of the fetal umbilical artery were 1.34±0.22,0.78±0.13,3.82±0.33 in the hypoxia group,significantly higher than 1.19±0.20,0.70±0.10,and 3.53±0.28 in the non-hypoxia group(P<0.05).The S-wave value and A-wave value of the superior vena cava blood flow were(57.69±3.46)cm/s and(26.10±2.16)cm/s in the hypoxia group,significantly higher than(52.46±4.10)cm/s and(23.65±1.68)cm/s in the non-hypoxia group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for diagnosing intrauterine hypoxia in high-risk pregnant women using S/D,S wave value,and A wave value were 0.751(95%CI:0.651-0.851),0.837(95%CI:0.762-0.912),and 0.813(95%CI:0.728-0.898),respectively,indicating relatively ideal diagnostic value.A nomogram diagnostic

关 键 词：高危孕妇 宫内缺氧 脐动脉超声 四维超声 诊断 

分 类 号：R714.43[医药卫生—妇产科学]