彩色多普勒超声联合监测子痫前期患者胎儿脐动脉大脑中动脉的价值

发布时间：2018-05-15 04:35

本文选题：轻度子痫前期 + 重度子痫前期　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的联合监测子痫前期患者32周-34周胎儿大脑中动脉(MCA)及脐动脉（UA）的PI(搏动指数)、S/D（收缩期与舒张期血流速度比值）、RI（血流阻力指数）等血流动力学变化规律，并通过测量胎儿BPD（双顶径）、FL（股骨长）、AC（腹围）、HC（头围）等数据估算体重，评估其在预测胎儿在宫内生长状况的价值，结合胎儿的有关结构生物学测量，以便临床及时的进行干预和治疗。研究方法选取2013年3月－2013年12月，就诊于山西医科大学第一医院妇产科门诊的孕妇96人，，年龄25-32岁，平均年龄28岁，孕龄为32-34周，平均33周，其中正常孕妇32人，无糖尿病等其他合并症孕妇，诊断轻度子痫前期32人，重度子痫前期32人，采用GE E8彩色多普勒超声检查仪,经腹部超声探头频率为3.5-5MHz。监测胎儿大脑中动脉(MCA)和脐动脉（UA）血流参数：收缩期与舒张期血流速度比值(S/D)、血流阻力指数(RI)、搏动指数(PI），并测量胎儿BPD、FL、AC、HC估算体重。结果 1、正常组胎儿体重及MCA平均水平：体重为2059.81kg±246.74kg，PI为1.56±0.23， RI为0.80±0.10，S/D为4.29±0.17；轻度子痫前期组胎儿体重及MCA的平均水平：体重为1915.20±217.88kg，PI为1.41±0.21，RI为0.76±0.01，S/D为4.09±0.21；重度子痫前期组胎儿体重及MCA的平均水平:体重为1600.36±261.06kg，PI为1.06±0.18，RI为0.55±0.08，S/D为2.24±0.16； 2、正常组、轻度子痫前期组和重度子痫前期组胎儿UA各指标PI、RI、S/D差别均有统计学意义。PI、RI、S/D是正常组胎儿最低，重度子痫前期组胎儿最高。本组研究中妊高征组患者UA各指标均高于正常妊娠组孕妇，且随患者病情逐渐加重呈逐渐递增趋势，轻度子痫前期组患者S/D值明显高于正常组，差异具有显著性((P0.05)，重度子痫前期组患者PI、RI、S/D值均明显高于正常组，差异极显著((P0.01)。 3、MCA各指标PI、RI、S/D与胎儿体重呈正相关；UA各指标PI、RI、S/D与胎儿体重呈负相关。结论 1、利用彩色多普勒超声，联合胎儿脐动脉、大脑中动脉的PI值、RI值、S/D值较单测脐动脉或脑中动脉的血流参数在预测胎儿宫内生长状况更为敏感。 2、子痫前期孕妇胎儿的大脑中动脉的血流动力学数RI值、RI值、S/D值与胎儿体重值呈负相关。 3、两者结合起来可以对子痫前期患者的胎儿度进行估重，为综合地评估胎儿宫内发育状况提供临床依据，以便临床及时进行干预和治疗。
[Abstract]:Purpose

The changes of PI ( pulsation index ) , S / D ( systolic and diastolic blood velocity ratio ) , RI ( blood flow resistance index ) and other hemodynamic changes of fetal brain ( MCA ) and umbilical artery ( UA ) were monitored in the early stage of pre - eclampsia .

Research Methods

From March 2013 to December 2013 , 96 pregnant women , aged 25 - 32 years , with an average age of 28 years and a gestational age of 32 - 34 weeks , were diagnosed as 32 - 34 weeks , with an average age of 28 years , with a mean age of 32 - 34 weeks , an average of 33 weeks .

Blood flow parameters of fetal brain middle artery ( MCA ) and umbilical artery ( UA ) were monitored : systolic and diastolic velocity ratio ( S / D ) , flow resistance index ( RI ) , beat index ( PI ) , and measured weight of fetal bpd , fl , ac , hc .

Results

1 . Body weight and MCA average of normal group : body weight was 2059.81 kg 卤 246.74kg , PI was 1 . 56 卤 0.23 , RI was 0.80 卤 0.10 , S / D was 4.29 卤 0.17 ;
The mean weight of fetal body weight and MCA in the pre - eclampsia group was 1915.20 卤 217.88kg , PI was 1.41 卤 0.21 , RI was 0.76 卤 0.01 , S / D was 4.09 卤 0.21 ;
The average weight of fetal weight and MCA in the pre - eclampsia group : body weight was 160.36 卤 268.06kg , PI was 1.06 卤 0.18 , RI was 0.55 卤 0.08 , S / D was 2.24 卤 0.16 ;

There was significant difference in PI , RI and S / D between normal group , mild sub - eclampsia group and severe pre - eclampsia group . The indexes of PI , RI and S / D were higher than those in the normal group , and the S / D value of patients with PIH group was significantly higher than that in normal group ( P < 0.01 ) .

3 . The indexes PI , RI and S / D of MCA were positively correlated with fetal body weight ;
There was a negative correlation between PI , RI , S / D and fetal body weight in UA .

1 . Using color Doppler ultrasound , the PI value , RI value and S / D value of umbilical artery and middle cerebral artery were more sensitive than those of single umbilical artery or middle cerebral artery .

2 . RI value , RI value and S / D value of middle cerebral artery were negatively correlated with fetal body weight .

3 . Taken together , the fetal degree of the pre - eclampsia can be estimated to provide a clinical basis for the comprehensive evaluation of the intrauterine development of the fetus , so as to intervene and treat the fetus in a timely manner .

【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】：R714.244;R445.1

【参考文献】