摘要
目的评价胎儿大脑中动脉(MCA)和脐动脉(UmA)血流动力学改变与预测新生儿缺血缺氧性脑病(HIE)的关系。方法选取于我院行超声检查孕妇1383例,孕周20～42周,采用彩色多普勒血流显像技术产前检测胎儿UmA、MCA的Vs、Vd、Vm、S/D、PI和RI,计算UmAPI/MCAPI值,确定上述指标的正常值范围。另选择77例晚期妊娠孕妇产前检测UmA和MCA的上述血流动力学参数,在1～3周内行剖腹产,根据临床和CT检查结果诊断HIE,将之分成两组即HIE组(20例)和非HIE组(57例)。采用协方差分析比较两组间各血流动力学参数的差异,并对其进行诊断试验评价。结果①1383例不同孕周胎儿MCA和UmA其Vs、Vd、Vm、S/D、PI和RI组间有显著差异(P<0.001);②HIE组和非HIE组其产前MCA、UmA血流参数组间有显著性差异。其中UmAVd(P<0.01)、PI(P<0.001);MCAVs(P<0.05)、Vd(P<0.001)、Vm(P<0.01)、PI(P<0.01)、UmAPI/MCAPI(P<0.001);③若以x-±2s作为正常值范围预测新生儿HIE,其UmAPI、MCAPI、UmAPI/MCAPI、UmAPI联合MCAPI的敏感性和特异性分别为35%、100%,30%、100%,45%、91.2%,50%、100%。结论UmAPI联合MCAPI及其比值对预测新生儿HIE有一定价值。对于具有明显I UGR、羊水过少或混浊、脐带绕颈并伴有异常UmAPI、MCAPI的孕妇,建议根据临床具体情况监测随访。
Objective To evaluate the relationship between the hemodynamic changes of middle cerebral artery （MCA）, umbilical artery（UmA） and neonatal hypoxic ischemic encephalopathy （HIE）. Methods Total of 1383 pregnant women with gestation age between 20-42 weeks were examined by prenatal color Doppler ultrasound. The hemodynamic parameters included Vs, Vd, Vm, S/D, PI and RI of UmA and MCA were measured. From the value of UmAPI and MCAPI, the UmAPI/MCAPI was calculated. Normal ranges of above parameters were defined based on those measurements. Another 77 pregnant women with late gestation had above all hemodynamic parameters on fetal UmA and MCA in 1-3 weeks before cesarean sections. HIE was diagnosed according to the clinical manifestation and CT outcomes. The 77 cases were divided into two groups： 20 cases with HIE and 57 cases without HIE. The covariance was used to analyze the difference of the above hemodynamic parameters between two groups, and the diagnostic test was used to evaluate these parameters. Results ① The all hemodynamlc parameters of MCA and UmA showed significant difference （P〈0. 001） between various gestational ages in 1383 fetuses.② There were significant differences in several hemodynamic parameters of MCA and UmA between HIE and without HIE groups, including Vd （P〈0.01）, PI （P〈0. 001） in UmA, Vs （P〈0.05）, Vd （P〈0.001）, Vm （P 〈0.01）, PI （P〈0.01） in MCA, and UmA/MCAPI （P〈0. 001）.③ If mean±2SD was regarded as the normal value to predict HIE, the sensitivity and specificity of UmAPI, MCAPI, UmAPI/MCAPI and UmAPI combining with MCAPI were 35% and 100%, 30% and 100%, 45% and 91.2%, 50% and 100%, respectively. Conclusion UmAPI combining with MCAPI and UmAPI/MCAPI were valuable to predict HIE. A follow-up Doppler uhrasonography was recommended for the cases with severe IUGR, oligohydramnios or amnion turbidity, umbilical cord around neck with abnormal UmAPI, MCAPI.
出处
《中国医学影像技术》
CSCD
北大核心
2005年第10期1552-1555,共4页
Chinese Journal of Medical Imaging Technology
关键词
超声检查
多普勒
新生儿缺血缺氧性脑病
胎儿缺氧
脐动脉
大脑中动脉
Ultrasonography, Doppler
Hypoxic ischemic encephalpathy
Fetal hypoxia
Umbilical artery
Cerebral middle artery
