彩超监测脐动脉与子宫螺旋动脉血流参数对高危妊娠的探讨

发布时间：2018-02-20 19:41

本文关键词： 高危妊娠脐动脉子宫螺旋动脉不良妊娠结局　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过彩色多普勒超声联合监测晚孕期高危妊娠患者胎儿脐动脉(umbilical artery, UA)及子宫螺旋动脉(spiral artery,SA)的血流参数指标,来探讨晚孕期高危妊娠胎儿脐动脉、子宫螺旋动脉血流动力学的变化,以及二者联合监测对预测围产儿结局的临床应用价值。方法：收集整理160例于2013年5月-2014年2月在山西省妇幼保健院产前检查的单胎晚期妊娠妇女为研究对象,分为两组,其中高危妊娠组80例,年龄24-42岁、孕周37-42周,正常妊娠组80例,年龄25-34岁、孕周37-41周,先进行产科超声的常规检查项目以除外胎儿发育方面的畸形,主要包括确定胎位,测量胎儿双顶径、头围、腹围、股骨长等生长指标、以及测量胎心率、羊水量等,然后再应用彩色多普勒超声对胎儿的脐动脉及母体子宫螺旋动脉的血流进行检测,分别测量以下血流参数：收缩期峰值速度与舒张期末速度之比值(systolic/diastolic,S/D阻力指数(resistance index,RI)及搏动指数(pulsatility index,PI),并对高危妊娠组及正常妊娠组所测得的各个参数及围产儿结局进行分析研究。统计学分析：采用SPSS16.0统计软件进行分析,各组测定结果以均数±标准差(x±s)表示,组间均数比较采用t检验,计数资料率的比较行χ2检验,P0.05为差异有统计学意义。结果：①高危妊娠组胎儿脐动脉及子宫螺旋动脉血流S/D、RI、PI值高于正常妊娠组,差别有统计学意义(P0.05)；②80例高危妊娠组中围产儿结局异常的有19例,发生率为23.75%,80例正常妊娠组中围产儿结局异常的仅有3例,发生率为0.38%,高危妊娠组围产儿结局异常的发生率明显高于正常妊娠组,差别有统计学意义(P0.05)；③高危妊娠组中当胎儿脐动脉和子宫螺旋动脉S/D值均高于正常范围者有15例,其中围产儿结局不良者有12例,占80.00%,不良妊娠结局发生率明显高于胎儿脐动脉和子宫螺旋动脉S/D值单独异常组,差别有统计学意义(P0.05)。结论：妊娠晚期彩色多普勒超声监测胎儿脐动脉、子宫螺旋动脉的血流状态,对预测妊娠结局的发生有临床价值；二者联合监测比单独监测胎儿脐动脉或子宫螺旋动脉对预测高危妊娠胎儿不良结局更有价值,监测子宫螺旋动脉可以作为脐动脉预测不良妊娠结局的补充。
[Abstract]:Objective: to study the blood flow parameters of fetal umbilical artery (UAV) and uterine spiral artery (spiral artery SAA) in high risk pregnancy patients during late pregnancy by color Doppler ultrasound (CDFI). Changes of uterine helical artery hemodynamics and clinical value of combined monitoring in predicting perinatal outcomes. Methods: one hundred and sixty pregnant women with single pregnancy, who were examined in Shanxi Maternal and Child Health Hospital from May 2013 to February 2014, were divided into two groups: 80 cases in high-risk pregnancy group, aged 24-42 years, 37-42 weeks of gestational age. 80 cases of normal pregnancy group, aged 25-34 years and 37 to 41 weeks of gestational age, underwent routine obstetric ultrasound examination to exclude fetal developmental malformations, including determination of fetal position, measurement of fetal biparietal diameter, head circumference, abdominal circumference, femur length and other growth indicators. The fetal heart rate and amniotic fluid were measured, and then the fetal umbilical artery and the maternal uterine spiral artery blood flow were detected by color Doppler ultrasound. The following parameters were measured: ratio of peak systolic velocity to end-diastolic velocity, resistance index (RI) and pulsatility index (Pi) of S / D resistance index and pulsatility index (Pi). The parameters and perinatal outcomes of high-risk pregnancy group and normal pregnancy group were evaluated. Statistical analysis: use SPSS16.0 statistical software to analyze, The results of each group were expressed as mean 卤standard deviation (x 卤s). T test was used to compare the mean among the groups, and 蠂 2 test was used to compare the count data rate. There was significant difference between the two groups (P0.05). Results the blood flow of fetal umbilical artery and uterine spiral artery in the high risk pregnancy group was significantly higher than that in the normal pregnancy group. There were 19 cases of abnormal perinatal outcome in the 280 cases of high risk pregnancy group with significant difference (P 0.05). The perinatal outcome was abnormal in only 3 cases (0.38) in the 80 normal pregnancy group. The perinatal outcome abnormality rate in the high-risk pregnancy group was significantly higher than that in the normal pregnancy group. The difference was statistically significant in 15 cases with fetal umbilical artery and uterine spiral artery S / D values higher than normal range in high risk pregnancy group, including 12 cases with perinatal adverse outcome. The incidence of adverse pregnancy outcome was significantly higher than that of fetal umbilical artery and uterine spiral artery S / D abnormality group, the difference was statistically significant (P 0.05). Conclusion: color Doppler ultrasound can be used to monitor the blood flow of fetal umbilical artery and uterine spiral artery in the third trimester of pregnancy, which has clinical value in predicting the outcome of pregnancy. The combined monitoring is more valuable than the single monitoring of fetal umbilical artery or uterine spiral artery in predicting the adverse outcome of the fetus in high-risk pregnancy. Monitoring the uterine spiral artery can be used as a supplement to the umbilical artery in predicting the adverse outcome of pregnancy.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.2;R445.1

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