彩色多普勒超声评价脐绕颈胎儿血流动力学与围生儿临床结局

发布时间：2018-01-10 03:26

本文关键词：彩色多普勒超声评价脐绕颈胎儿血流动力学与围生儿临床结局　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨脐绕颈胎儿脐动脉及大脑中动脉的血流动力学变化,判定围产儿预后状况,评价彩色多普勒血流显像技术在预测胎儿宫内缺氧及围生儿临床结局方面的使用价值。方法:选取2016年5月至2016年12月就诊于山西大医院,在我院产前检查并经超声证实的脐绕颈、单胎、头位胎儿的孕妇作为观察对象,以孕周在37~41+6周,我院收治的97例脐带绕颈胎儿为研究对象,通过彩色多普勒超声检查证实其胎儿脐带绕颈,随后进行无应激试验,根据胎心监护判断缺氧与否进行分组,其结果显示非缺氧有59例,缺氧有38例,然后测量脐动脉与大脑中动脉血流动力学指数(RI、PI、S/D),并追踪产后羊水性状、试产过程中胎心率变化及分娩方式等。结果:缺氧组脐动脉血流动力学指数明显高于非缺氧组,而大脑中动脉血流动力学指数明显低于非缺氧组,差异具有统计学意义(P0.05)。缺氧组脐动脉收缩期峰值血流速度与舒张末期血流速度之比(S/D)为(3.24±0.04)、脐动脉血流阻力指数(RI)为(0.77±0.06)、脐动脉搏动指数(PI)为(1.70±1.71),大脑中动脉的S/D为(3.28±0.18)、大脑中动脉阻力指数(RI)为(0.60±0.04)、大脑中动脉搏动指数(PI)为(1.49±0.10),羊水污染率47.36%(18/38),阴道试产胎心异常率55.26%(21/38),剖宫产率42.10%(16/38);非缺氧组脐动脉收缩期峰值血流速度与舒张末期血流速度之比(S/D)为(2.27±0.07)、脐动脉阻力指数(RI)为(0.51±0.04)、脐动脉搏动指数(PI)为(1.10±0.33),大脑中动脉S/D为(4.78±0.14)、大脑中动脉阻力指数(RI)为(0.82±0.03)、大脑中动脉搏动指数(PI)为(1.75±0.03),羊水污染率18.64%(11/59),阴道试产胎心异常率22.03%(13/59),剖宫产率15.25%(9/59),二者差异均有统计学意义(均P0.05)。结论:1.脐绕颈胎儿UA-S/D、UA-RI、UA-PI、MCA-RI、MCA-S/D、MCA-PI及羊水污染对于评价胎儿宫内安危状况以及新生儿出生时情况具有临床参考价值。2.彩色多普勒超声在检查脐绕颈胎儿血流变化情况方面敏感、简单、安全,且其提供的信息准确、丰富,可以为临床医师对患者的进一步诊治及预防提供定量依据。3.及时合理利用彩色多普勒超声对脐绕颈胎儿大脑中动脉及脐动脉血流情况进行联合监测,可以更全面、客观的评价胎儿宫内情况,从而更好的服务于临床。
[Abstract]:Objective: to investigate the hemodynamic changes of umbilical artery and middle cerebral artery (MCA) in fetuses around umbilical neck and to determine the prognosis of perinatal infants. To evaluate the value of color Doppler flow imaging (CDFI) in predicting fetal anoxia and perinatal clinical outcome. Methods: selected from May 2016 to December 2016 in Shanxi Hospital. The pregnant women with umbilical cord around neck, single fetus and head fetus confirmed by ultrasound before prenatal examination in our hospital were studied. 97 cases of umbilical cord around neck fetus were treated in our hospital at 37 ~ 466 weeks of gestation. The fetal umbilical cord around the neck was confirmed by color Doppler ultrasound, and then no stress test was carried out. According to fetal heart monitoring, the fetal umbilical cord was divided into groups. The results showed that there were 59 cases of non-hypoxia and 38 cases of hypoxia. The hemodynamic index of umbilical artery and middle cerebral artery (MCA) was measured, and the characteristics of postpartum amniotic fluid were tracked. Results: the umbilical artery hemodynamic index of hypoxia group was significantly higher than that of non-hypoxia group, while the hemodynamic index of middle cerebral artery was significantly lower than that of non-hypoxia group. The ratio of peak systolic velocity to end-diastolic velocity of umbilical artery in hypoxia group was 3.24 卤0.04). The umbilical artery resistance index (RI) was 0.77 卤0.06m, and the umbilical artery pulsatility index (Pi) was 1.70 卤1.71). The S / D of the middle cerebral artery was 3.28 卤0.18, and the resistance index of the middle cerebral artery was 0.60 卤0.04). The pulsatile index of middle cerebral artery (Pi) was 1.49 卤0.10m, the amniotic fluid contamination rate was 47.36 and 18 / 38, and the abnormal rate of vaginal fetal heart was 55.26 / 38). The cesarean section rate was 42.10% or 16 / 38%; In the non-hypoxia group, the ratio of peak systolic velocity to end-diastolic velocity was 2.27 卤0.07, and the umbilical artery resistance index (RI) was 0.51 卤0.04). The pulsatile index of umbilical artery was 1.10 卤0.33 and the S / D of middle cerebral artery was 4.78 卤0.14). The resistance index of middle cerebral artery (Ri) was 0.82 卤0.03 and the pulsatile index of middle cerebral artery was 1.75 卤0.03). The amniotic fluid contamination rate was 18.64%, the abnormal rate of vaginal fetal heart was 22.03%, the cesarean section rate was 15.25% 9 / 59). There were significant differences between the two groups (P 0.05). Conclusion: 1. UA-S / D UA-RIV UA-RI UA-PII MCA-RIN MCA-Sr D around the cervix of umbilical cord fetus. MCA-PI and amniotic fluid contamination have clinical reference value in evaluating fetal intrauterine safety and neonatal condition. 2. Color Doppler ultrasound is sensitive in detecting fetal blood flow around umbilical neck. Simple, safe, and it provides accurate and rich information. It can provide quantitative basis for further diagnosis, treatment and prevention of patients. 3. Timely and reasonable use of color Doppler ultrasound to umbilical around the neck fetal middle cerebral artery and umbilical artery blood flow monitoring. More comprehensive and objective evaluation of fetal intrauterine conditions, so as to better serve the clinical.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R714.5

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