催产素激惹试验中胎儿脐动脉血流变化及其临床意义  

Umbilical Artery Doppler Velocimetry During Oxytocin Challenge Test and Its Clinical Significance

作　　者：李辉[1] 尚涛[1] 杨光 毕丽华 

机构地区：[1]中国医科大学第二临床学院妇产科,沈阳110004 [2]大连市妇幼保健院

出　　处：《中华围产医学杂志》2003年第3期131-133,共3页Chinese Journal of Perinatal Medicine

摘　　要：目的　研究催产素激惹试验 (oxytocin challenge test,OCT)在脐动脉血流异常的高危妊娠中应用价值 ,及 OCT试验中同时行脐动脉血流检测的临床意义。　方法　对 170例脐动脉血管阻力增加但仍有舒张期前进血流的患者及 178例脐动脉血流正常的患者行 OCT试验 ,同时于 OCT试验中子宫收缩时和收缩间歇进行脐动脉血流检测。对于 OCT中子宫收缩时脐动脉血管阻力增加>0 .5的阳性 OCT患者于当日行剖宫产终止妊娠 ,余者试行阴道分娩。　结果　在脐动脉血流异常组和正常组 ,阳性 OCT发生率分别为 4 5 .3%和 10 .1% ,差异有显著性 (P<0 .0 0 1) ,伴子宫收缩时脐动脉血流增高 >0 .5的阳性 OCT发生率分别为 37.4 %和 6 .7% ,差异有显著性 (P<0 .0 0 1) ;对于 19例 OCT中没有脐动脉血流增高的阳性 OCT者 ,15例成功阴道分娩。在阴性 OCT组共有 30例患者在分娩过程中因胎儿宫内窘迫进行了手术产 (ODFD) ,其中 2 4例患者 OCT中子宫收缩时脐动脉血管阻力增加 >0 .5。对于不良围产期结果患者 ,78.6 %～ 81.8%发生于 ODFD患者。　结论　 OCT结合脐动脉血流检测对弥补 OCT假阳性和假阴性不足、筛选潜在宫内缺氧的脐动脉血流异常高危儿和改善围产期预后有重要临床价值。Objective To study the value of Oxytocin challenge test (OCT) in high-risk pregnancy with abnormal umbilical artery resistance and the clinical significance of performing the umbilical velocimetry during OCT. Methods One hundred and seventy patients with abnormal umbilical artery resistance but maintained forward diastolic flow and 178 patients with normal umbilical blood flow received OCT, umbilical velocimetry was conducted during OCT. If the umbilical artery pulsatility index (PI) increased more than 0.5 during contraction and OCT was positive, cesarean section was performed in the same day, otherwise, vaginal delivery was tried. Results The rate of positive OCT was 45.3% and 10.1% respectively and the rate of positive OCT with umbilical artery PI increasing more than 0.5 was 37.4% and 6.7% respectively in abnormal umbilical artery flow resistance group and normal umbilical artery flow group ( P <0.001). For 19 cases with positive OCT but no increase in umbilical artery PI, 15 cases were successful vaginal delivery. In negative OCT group, 30 cases had the operative delivery for fetal distress (ODFD) during labor, among which the umbilical artery flow resistance of 24 cases increased during OCT ( P <0.001). For cases of poor perinatal outcome, 78.6%～81.8% were ODFD. Conclusions Umbilical artery doppler velocimetry during OCT is a good method to detect compromised fetus earlier in cases with abnormal umbilical artery blood flow; it is important in reducing the rate of the false positive and false negative OCT; it has clinical significance in improving the perinatal outcome.

关 键 词：催产素激惹试验 胎儿 脐动脉血流异常 高危妊娠 脐动脉血流检测 产前诊断 血流速度 

分 类 号：R714.5[医药卫生—妇产科学]