脐绕颈胎儿脐动脉及大脑中动脉血流动力学指标的比较分析(1)
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[摘要] 目的:分析脐带绕颈胎儿脐动脉和大脑中动脉血流动力学参数,为临床判断宫内缺氧提供客观依据。方法:比较彩色多普勒超声检测200例正常妊娠胎儿和209例脐带绕颈胎儿脐动脉(UA)及大脑中动脉(MCA)血液动力学指标,以搏动指数(PI)、阻力指数(RI)、收缩期峰值/舒张期峰值(S/D)为分析指标。结果:正常妊娠胎儿UA和MCA的PI、RI、S/D与孕年呈负相关,脐带绕颈胎儿UA阻力指数增高明显,而MCA阻力指数降低显著。两组UA和MCA的PI、RI、S/D有显著性差异。结论：产前监测脐带绕颈胎儿的UA、MCA血流指数,可以了解胎儿胎盘循环和颅脑循环状态,预测胎儿宫内血氧状况，对了解胎儿血循环状况和及时预防胎儿宫内窘迫具有实用价值。
[关键词] 脐带绕颈; 胎儿; 脐动脉;大脑中动脉
[中图分类号] R714.43 [文献标识码] A [文章编号] 1671-7256(2011)02-0165-04
doi：10.3969/j.issn.1671-7256.2011.02.013
Comparative analysis of umbilical artery and middle
cerebral artery in fetus with cord around neck
XIE Ting-ting, FAN Xue-mei
(Department of B Ultrasound, Xinghua Peoples Hospital, Xinghua 225700, China)
[Abstract] Objective: To analyze of the dynamic parameter umbilical artery and middle cerebral artery of fetus with the umbilical cord around neck to provide objective proofs diagnosing intrauterine fetal anoxia. Methods: To compare umbilical artery(UA)with middle cerebral arterys(MCAs), Doppler parameter was used in 200 healthy cases and 209 cases with cord around neck, taking pulse index (PI), resistance index(RI) and the peak-systolic/ diastolic ratio(S/D) as analysis target. Results: In the normal group, the PI, RI and S/D of UA and MCA were negatively correlated with ages of women. In the cord around neck group, the PI, RI and S/D of UA were increased significantly, the PI, RI and S/D of MCA were decreased significantly. PI, RI and S/D of the UA and MCA in the two groups had significant differences. Conclusion: Before we deliver a baby, the blood flow of UA and MCA of the fetus should be monitored in order to know the fetal placenta circulation and the fetal brain circulation, thus to prevent intrauterine fetal anoxia from happening.
[Key words] cord around neck； fetus； umbilical artery； middle cerebral artery
脐带绕颈是产科常见的并发症,发生率为20%～34%[1],是造成宫内缺氧导致胎儿窘迫的重要原因之一,围生儿死亡率较高,临产前确诊较为困难。本研究通过彩色多普勒超声(彩超)检测足月脐带绕颈胎儿的脐动脉(UA)及大脑中动脉(MCA)的血流参数并进行分析,探讨预测胎儿宫内缺氧的可靠方法,现报道如下。
1 资料与方法
1.1 一般资料
选择我院2008年8月至2009年8月单胎头位足月的初产妇1 146例为观察对象。入组标准：(1) 均于产前、产时常规行彩超检查有无脐带绕颈,并经分娩时证实；(2) 排除有妊娠合并症及并发症者；(3) 均为初产妇,年龄21～36岁(平均26岁),孕周37～42周(平均39周),无引产史,无骨盆狭窄及头盆不称 ......
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