超声检测孕晚期脐带绕颈深度与脐动脉、大脑中动脉血流相关性分析

发布时间：2018-03-05 03:32

本文选题：大脑中动脉　切入点：脐动脉　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的：探讨超声检测孕晚期脐带绕颈深度与大脑中动脉及脐动脉血流指标的相关性,用于预测围生期胎儿宫内缺氧和宫内窘迫的风险,为临床产科医师对伴脐绕颈的临产孕妇选择合理的生产方式提供有效的决策依据。研究方法：选取孕37-41周脐带绕颈胎儿139例,其中绕颈一周者124例,绕颈两周及以上者15例。均为单胎,孕妇年龄20-32岁,并取28例不伴脐带绕颈的相同孕周范围胎儿作为对照组,均已通过胎儿常规检查排除先天性胎儿畸形并经分娩后证实。用彩色多普勒超声分别检测对照组及脐带绕颈组胎儿大脑中动脉(middle cerebral artery, MCA)及脐动脉(umbilical artery, UA)的收缩期最大流速与舒张期末流速的比值(S/D)、阻力指数(RI)及搏动指数(PI),同时分析脐带绕颈组胎儿颈部皮肤压迹深度与UA血流指数的相关性。并追踪观察其胎心监测结果、生产方式、产程异常几率、第二产程时间,并对结果进行相关统计学分析。结果：1.绕颈两周及以上者共15例,皮肤压迹最小深度为0.72cm,最大深度为1.18cm,平均深度0.872±0.135cm。绕颈一周者124例,皮肤压迹最小深度为0.35cm,最大深度为1.38cm。依据皮肤压迹深度进行分组,皮肤压迹深度小于0.60cm者19例,平均深度：0.501±0.155cm；压迹深度0.60-0.69cm者39例,平均深度：0.669±0.072cm；压迹深度：0.70-0.79cm者36例,平均深度：0.735±0.063cm；压迹深度0.80-0.89cm者18例,平均深度：0.841±0.057cm；压迹深度0.90cm以上者12例,平均深度：0.954±0.083cm。分别与对照组比较,发现UA的各项血流指标均未见明显差异；同时各观察组间相互比较,UA的各项血流指标亦未见明显差异。 2.随绕颈深度的增加,MCA的S/D、 RI、 PI逐渐增加。绕颈两周及以上组MCA的S/D、RI、 PI均较对照组升高,其差异有统计学意义(p＜0.05)；压迹深度0.80～0.89cm组及0.90cm以上组MCA的S/D、 RI、 PI均较对照组及其他观察组升高,统计学有显著性差异(p＜0.01)；压迹深度小于0.60cm组、压迹深度0.60～0.69cm组及压迹深度0.70～0.79cm组与对照组比较及各观察组间比较MCA的各项血流指标均未见明显差异。 3.围产儿结局分析：绕颈组与对照组比较：绕颈两周及以上组全部剖宫产。绕颈一周组剖宫产几率明显升高,阴道产第二产程时间延长,以绕颈深度大于0.80cm者显著,其差异均有统计学意义(p＜0.05)；绕颈深度小于0.80cm组与对照组间比较：其胎心监护异常几率及产程异常几率较对照组虽有升高,但其差异无统计学意义；压迹深度大于0.80cm组与对照组间比较：胎心监护异常几率明显增高,其差异有统计学意义(p＜0.05)。结论：本组研究表明在预测胎儿是否出现宫内窘迫方面,大脑中动脉的各项血流指标较脐动脉的血流指标更为敏感。同时绕颈一周且较松(颈后皮肤压迹深度小于0.80cm)的情况下胎儿各项血流指标未见明显异常,孕妇及医务人员不必过分紧张焦虑；但绕颈较紧(颈后皮肤压迹深度0.80cm以上)者及两周以上者大脑中动脉的S/D. PI、RI均较对照组显著升高,其差异具有统计学意义,可能会导致胎儿宫内缺氧,必须引起临床医师足够的重视。同时脐带绕颈会影响胎儿先露下降,导致第二产程时间延长,并且胎心监护异常几率增高,尤其以绕颈较紧、周数较多者显著。因此对于脐带绕颈者,临床产科医师必需加强产前监护并适时合理选择分娩方式,特别是对脐带绕颈较紧(压迹深度0.80cm以上者)、周数较多者更要慎重,以减少围产儿不良结局的发生。利用测量脐带绕颈颈后皮肤压迹深度这一检测方法判断脐带缠绕的松紧程度简单易行,有利于临床推广。这一检测方法对于间接判断脐带缠绕的松紧程度切实有效,更适合临床需要,可以为脐带绕颈孕妇分娩方式的选择提供有价值的决策依据。
[Abstract]:Objective: To investigate the correlation between ultrasonic detection of late pregnancy umbilical cord around the neck and the depth of the middle cerebral artery and umbilical artery blood flow index, for the prediction of perinatal fetal hypoxia and fetal distress risk, provide an effective basis for clinical obstetrician for pregnant women with umbilical cord around the neck of the rational choice of production mode.
Methods: select 37-41 weeks of gestation fetuses with umbilical cord around the neck in 139 cases, including 124 cases around the neck a week, around the neck for two weeks or more. 15 cases were singleton pregnant women, age 20-32 years, and 28 cases with cord around the neck of the same gestational age range of the fetus as the control group, have through routine examination to exclude fetal congenital fetus malformation and confirmed after delivery. The control group were detected and the umbilical cord around the neck group in the fetal brain artery with color Doppler ultrasound (middle cerebral, artery, MCA) and umbilical artery (umbilical artery UA) the ratio of the systolic peak velocity and diastolic velocity (S/D), resistance index (RI) and pulsatility index (PI), correlation analysis of umbilical cord around the fetal neck neck skin group impressio depth and UA blood flow index. At the same time and followed up the fetal heart monitoring results, the mode of production, the probability of abnormal labor, the second stage of labor time, and related statistics on the results Study analysis.
Results: 1. around the neck for two weeks and more than 15 cases of skin impressio minimum depth is 0.72cm, the maximum depth is 1.18cm, 124 cases a week average depth of 0.872 + 0.135cm. around the neck, skin impressio minimum depth is 0.35cm, the maximum depth is 1.38cm. on the basis of skin impression depth were divided into two groups, 19 cases of skin. The impression of depth less than 0.60cm in average depth: 0.501 + 0.155cm; 39 cases, impressio depth 0.60-0.69cm average depth: 0.669 + 0.072cm; impressio depth: 36 cases, 0.70-0.79cm average depth: 0.735 + 0.063cm; 18 cases, impressio depth 0.80-0.89cm average depth: 0.841 + 0.057cm; 12 cases, impressio the depth of more than 0.90cm in average depth: 0.954 + 0.083cm. respectively compared with the control group, the blood flow index of UA had no significant difference; at the same time, the observation group compared with each other, the blood flow index of UA also showed no significant difference.
2. with the increase of depth around the neck, MCA, S/D, RI, PI gradually increased. Around the neck for two weeks and above group MCA S/D, RI, PI were higher than those in control group, the difference was statistically significant (P < 0.05); impressio depth of 0.80 ~ 0.89cm group and 0.90cm group than MCA S/D. RI and PI were compared with control group, the observation group increased, there was statistically significant difference (P < 0.01); the impression of depth is less than the 0.60cm group, the impression of depth of 0.60 ~ 0.69cm group and 0.70 to the blood pressure trace depth index of 0.79cm group compared with the control group and the observation group MCA showed no obvious the difference.
3. perinatal outcome analysis: around the neck group compared with the control group: around the neck for two weeks and above all cesarean section around the neck a week. Probability of cesarean section increased vaginal delivery during the second stage of labor time, at around the neck depth more than 0.80cm significantly, the differences were statistically significant (P < 0.05); around the neck depth is less than the 0.80cm group and the control group comparison: the abnormal fetal heart rate and abnormal labor rate was higher than the control group, but the difference was not statistically significant; the impression of depth is greater than the 0.80cm group and the control group comparison: abnormal fetal heart rate increased obviously, there was a statistically significant the difference (P < 0.05).
Conclusion: This study showed that in the prediction of fetal intrauterine distress or blood flow, blood flow index in the index of middle cerebral artery in the umbilical artery is more sensitive. At the same time around the neck a week and loose (neck skin impression depth is less than 0.80cm) under the condition of the fetus blood flow index had no obvious abnormalities, pregnant women and the medical staff do not have too much anxiety; but more tightly around the neck (cervical skin after impression of depth is more than 0.80cm) and more than two weeks in the brain artery of S/D. PI and RI were significantly higher than the control group, the difference was significant, may cause fetal hypoxia, the clinician must pay enough attention to at the same time. Umbilical cord around the neck will affect fetal presentation decline, resulting in the second stage of labor time, and increase the probability of abnormal fetal heart rate monitoring, especially around the neck is tight, the number of weeks was more significant. So the umbilical cord around the neck, clinical production Physicians must strengthen prenatal care and timely delivery mode selection, especially on the umbilical cord around the neck is tight (impressio depth more than 0.80cm), the number of weeks is much more carefully, to reduce perinatal adverse outcomes. By measuring the umbilical cord around the neck neck skin after the impressio depth detection method to judge the tightness the degree of the umbilical cord is simple, is conducive to clinical practice. This method is effective to indirectly determine the tightness of cord entanglement, more suitable for clinical needs, can provide valuable basis for decision making of umbilical cord around the neck delivery options.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.5;R445.1

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