孕晚期应用彩色多普勒超声评估胎儿生长受限及判断其妊娠结局的研究

发布时间：2018-03-10 08:42

本文选题：孕晚期　切入点：胎儿生长受限　出处：《江苏大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:胎儿生长受限是围产期常见并发症之一,此类新生儿即使存活其儿童期体格发育也较正常儿缓慢,并可能伴有智力发育低下。彩色多普勒血流影像技术(CDFI)应用于产科可更方便的获取FGR胎儿循环信息,其在评估胎儿生长受限及判断其妊娠预后的价值也获得了临床医生的重视和认可,其中孕晚期超声可通过监测血流参数确定是否出现胎儿宫内缺氧并了解其严重程度,进而为临床是否终止妊娠提供有效依据。目的:探讨应用彩色多普勒超声评估孕晚期孕妇胎儿脐动脉、大脑中动脉和主动脉弓峡部血流参数在评估胎儿生长受限及判断妊娠结局中的临床价值。方法:选取在我院产科行超声检查的孕晚期孕妇180例。其中临床诊断为胎儿宫内生长受限的胎儿52例,将其设为FGR组。经临床常规检查诊断无异常128例,将其设为对照组。两组孕妇均孕34~36周。采用彩色多普勒超声检测胎儿脐动脉(UA)和大脑中动脉(MCA),测量收缩期峰值流速(PSV)、舒张期末流速(EDV)、搏动指数(PI)、阻力指数(RI)和PSV/EDV(S/D)值。检测主动脉弓峡部(Aol),测量Aol的收缩期峰值流速PSV以及收缩末反流流速(ESRV)。对两组妊娠结局情况进行随访,比较两组胎儿脐动脉、大脑中动脉和主动脉峡部血流参数值差异。评价脐动脉、大脑中动脉和主动脉弓峡部的血流参数诊断胎儿宫内生长受限及判断妊娠结局的价值。结果:FGR组围生期异常妊娠结局发生率明显高于对照组(P0.01)。FGR组UA S/D、PI、RI的参数均与对照组比较差异有统计学意义(P0.05),PSV值比较差异无统计学意义(P0.05)。两组MCA S/D、PI、RI的参数比较差异有统计学意义(P0.05),PSV无统计学意义(P0.05)。两组胎儿主动脉峡部(Aol)ESRV有统计学意义,但组间PSV值比较无统计学差异(P0.05),FGR组ESRV值高于同孕期对照组,比较有统计学差异(P0.05)。将UA和MCA的S/D、RI、PI值以及Ao I的ESRV作ROC曲线分析,各指标都具有鉴别对照组和FGR组的能力,并以ROC曲线结果得出最佳诊断值,分别以UA-RI=0.66(敏感度=0.90;特异性=0.75)、MCA-RI=0.69(敏感度=0.88;特异性=0.77)和Ao I-ESRV=35.5(敏感度=0.85;特异性=0.94)分别将FGR组患者分组成高低表达组(UA-RI高vs UA-RI低;MCA-RI高vs MCA-RI低以及Ao I-ESRV高vsAo I-ESRV低),分析FGR孕妇中各高低组发生宫内缺氧程度和预测妊娠结局价值比较,MCA-RI高低组和Ao I-ESRV高低组轻重缺氧程度组间比较差异有统计学意义,UA-RI组无统计学意义。结论:孕晚期脐动脉以及大脑中动脉S/D、RI、PI值和主动脉弓峡部ESRV均为评价FGR的敏感指标;通过分析脐动脉、大脑中动脉、主动脉弓峡部血流参数诊断胎儿生长发育受限能进一步明确缺氧程度,具有重要的临床应用价值。
[Abstract]:Background: fetal growth restriction is one of the common complications during perinatal period. Even if these newborns survive their childhood physical development is slower than normal infants. Color Doppler flow imaging (CDFI) can be used in obstetrics to obtain fetal circulation information of FGR more easily. Its value in evaluating fetal growth restriction and judging the prognosis of pregnancy has also been valued and recognized by clinicians. In the third trimester, ultrasound can determine whether fetal intrauterine hypoxia occurs and understand its severity by monitoring blood flow parameters. Objective: to evaluate the fetal umbilical artery of late pregnant women by color Doppler ultrasound (CDFI). The clinical value of blood flow parameters of middle cerebral artery and aortic arch isthmus in the evaluation of fetal growth restriction and the outcome of pregnancy. Methods: 180 cases of late pregnancy who underwent ultrasonography in our hospital were selected. 52 fetuses with intrauterine growth restriction, The patients were divided into FGR group and no abnormal cases were diagnosed by routine clinical examination. The pregnant women in both groups were assigned to the control group. The fetal umbilical artery (UAA) and MCAA were detected by color Doppler ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (Pi), resistance index (RI) and PSV / EDV / Sr / D were measured. The peak systolic velocity (PSV) and end-systolic reflux velocity (PSV) of Aol were measured. To compare the blood flow parameters of fetal umbilical artery, middle cerebral artery and aortic isthmus between the two groups. The value of blood flow parameters of middle cerebral artery and aortic arch isthmus in diagnosing fetal intrauterine growth restriction and predicting pregnancy outcome results the incidence of perinatal abnormal pregnancy outcome in the FGR group was significantly higher than that in the control group (P 0.01). There was no significant difference in PSV between the two groups (P 0.05). There was no significant difference in the parameters of MCA S / D ~ (I) I RI between the two groups. There was no significant difference between the two groups (P = 0.05). There was no significant difference between the two groups (P > 0.05). There was a significant difference between the two groups in the fetal aorta isthmus (Aol) ESRV, and there was no significant difference between the two groups (P < 0.05). However, there was no significant difference in PSV between the two groups. The ESRV values of the two groups were higher than those of the control group during pregnancy, and the difference was significant (P 0.05). The analysis of ROC curve between UA and MCA and the ESRV of ao I showed that each index had the ability to differentiate between the control group and the FGR group. The best diagnostic value was obtained from the results of ROC curve. UA-RIV 0.66 (sensitivity 0.90; specificity 0.75; MCA-RIV 0.69 (sensitivity 0.88; specificity 0.77)) and Ao I-ESRV35.5 (sensitivity 0.85; specificity 0.94) were used to analyze the high UA-RI vs UA-RI low MCA-RI and Ao I-ESRV high vsAo I-ESRV low vsAo I-ESRV of FGR pregnant women. The patients were divided into two groups: UA-RI high vs UA-RI low MCA-RI high and Ao I-ESRV high vsAo I-ESRV low, respectively. The patients with FGR were divided into two groups: UA-RI high vs UA-RI low MCA-RI high and Ao I-ESRV high vsAo I-ESRV low. Comparison of the degree of intrauterine hypoxia and the value of predicting pregnancy outcome in the middle and low groups there was no significant difference between the MCA-RI group and the Ao I-ESRV group in the degree of severe hypoxia. Conclusion: there is no significant difference in the UA-RI group. The Pi value of the middle cerebral artery S / D ESRV and ESRV of aortic arch isthmus were sensitive indexes to evaluate FGR. The analysis of umbilical artery, middle cerebral artery, aortic arch isthmus blood flow parameters in fetal growth and development limitation can further determine the degree of hypoxia, which has an important clinical application value.
【学位授予单位】：江苏大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R714.5

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