摘要
目的探讨彩色多普勒超声检测足月妊娠孕妇左侧卧位下腔静脉、子宫动脉及胎儿脐动脉的血流动力学变化。方法回顾分析2014年1月—2019年10月在东南大学医学院附属江阴医院就诊的73例单胎足月妊娠孕妇的超声资料。孕妇年龄20~42(29.34±5.16)岁,孕周37~40.3(39.1±1.0)周。孕妇均采用彩色多普勒超声诊断仪进行检查。观察项目:(1)比较73例孕妇平卧及左侧卧位15°时,于剑突偏右、肝静脉汇入第二肝门处测量的下腔静脉内径和血流最高流速,以及子宫动脉和脐动脉的收缩期峰值最高流速(PSV)、舒张末期流速(EDV)、搏动指数(PI)、阻力指数(RI)、PSV/EDV(S/D);(2)据超声检查时有无出现仰卧位低血压综合征(SHS)将孕妇分为有症状组和无症状组,分别比较两组孕妇平卧位、左侧卧位15°时下腔静脉内径和血流最高流速,子宫动脉、脐动脉血流动力学参数,以及孕妇的年龄、孕次、产次、孕周、体质量指数(BMI)及新生儿体质量等;(3)比较有症状组孕妇平卧位和左侧卧位15°时下腔静脉内径、血流最高流速。结果(1)73例孕妇左侧卧位15°时下腔静脉内径[1.71(1.59,1.85)cm]大于平卧位时[1.37(1.22,1.52)cm],血流最高流速[23.73(20.22,28.59)cm/s]高于平卧位时[21.80(19.95,26.62)cm/s],差异均有统计学意义(Z=7.274、2.108,P值均<0.05);而子宫动脉及胎儿脐动脉血流动力学参数PSV、EDV、PI、RI、S/D差异均无统计学意义(P值均>0.05)。(2)73例孕妇中,行超声检查时出现SHS24例(32.87%)。有症状组和无症状组孕妇平卧位和左侧卧位15°时下腔静脉内径和血流最高流速以及子宫动脉脐动脉血流动力学参数比较,差异均无统计学意义(P值均>0.05);两组孕妇年龄、孕次及产次差异均无统计学意义(P值均>0.05),而有症状组孕妇的孕周、BMI及新生儿体质量均高于无症状组,差异均有统计学意义(P值均<0.05)。(3)24例SHS孕妇左侧卧位15°时下腔静脉内径及血流最高流速均高于平卧位时,差异均有统计学意义(Z=4.302、2.029,P值均<0.05)。结论足月妊娠孕妇平卧位时行超声检查时可能会发生SHS,虽然孕妇平卧及左侧卧位15°时,下腔静脉内径、血流最高流速有差异,但是孕妇子宫动脉及胎儿脐动脉的血流动力学无变化;孕妇的孕周、BMI及胎儿体质量可能是SHS的影响因素。
Objective To observe the haemodynamic differences among the inferior vena cava,uterine artery and umbilical artery on left lateral position in the third trimester of pregnancy with color Doppler ultrasonography(US).Methods Retrospective analysis was performed on the ultrasonographic manifestations of 73 cases of single-child full-term pregnancies that resulted in healthy deliveries in a Jiangyin Hospital Affiliated to the Medical College of Southeast University from January 2014 to October 2019.The pregnant women were 20-42(29.34±5.16)years old and at 37-40.3(39.1±1.0)weeks of gestation.They were examined with color Doppler US.(1)The internal diameter and maximum blood flow velocity of the inferior vena cava and haemodynamic parameters,including peak systolic velocity(PSV),end diastolic velocity(EDV),pulsatility index(PI),resistivity index(RI)and PSV/EDV(S/D)of the uterine and umbilical arteries in the supine position were compared with those in the 15°left lateral position.(2)The occurrence of supine hypotension syndrome(SHS)during ultrasound examination was observed,and the parameters of pregnant women with supine hypotension syndrome were compared with those without.These parameters included the internal diameter and maximum blood flow velocity of the inferior vena cava,the haemodynamic parameters of uterine and umbilical arteries,age,number of pregnancies,number of births,gestational age,body mass index(BMI)of the pregnant woman and foetal weight.(3)The diameter and maximum blood flow velocity of pregnant women with SHS of inferior vena cava were compared between the supine position and 15°left lateral position.Results(1)The median diameter of the inferior vena cava on the 15°left lateral position in 73 pregnant women was wider than that in the supine position(1.71[1.59,1.85]cm vs.1.37[1.22,1.52]cm,Z=7.274,P<0.05).The median maximum blood flow velocity on the 15°left lateral position was higher than that in the supine position(23.73[20.22,28.59]cm/s vs.21.80[19.95,26.62]cm/s,Z=2.108,P<0.05).No statistically significant differences in PSV,EDV,PI,RI and S/D of the uterine and umbilical arteries were observed between pregnant women on the supine position and those in the 15°left lateral position(all P values>0.05).(2)Among the 73 cases,24(32.87%)had SHS,whereas 49(67.13%)pregnant women had none.The internal diameter and maximum blood flow velocity of the inferior vena cava and the haemodynamic parameters of the uterine and umbilical arteries on the supine position were compared with those on the 15°left lateral position.The differences were not statistically significant(all P values>0.05).Moreover,no significant differences in age,the number of pregnancies and the number of births were observed between the two groups(all P values>0.05),and pregnant women with SHS had higher gestational weeks,BMIs and foetal weights(all P values<0.05).(3)In the 24 pregnant women with SHS,the inner diameter and maximum blood flow velocity of the inferior vena cava on the 15°left lateral position were higher than those on the supine position(all P values<0.05).Conclusions SHS may occur during the ultrasound examination of full-term pregnant women,the degree of compression of the inferior vena cava can be reduced,and the symptoms disappear when pregnant women immediately change to the left lateral position.The haemodynamics of the uterine and foetal umbilical arteries did not change,that is,the hypotension of pregnant women did not affect uterine placenta blood perfusion.Moreover,pregnant weeks,BMI of the pregnant woman and foetal weight may be influential factors for SHS.
作者
薛勤
景孜涵
郭然
蒋美琴
梅吉
李嘉
王玲
Xue Qin;Jing Zihan;Guo Ran;Jiang Meiqin;Mei Jie;Li Jia;Wang Ling(Department of Ultrasound Diagnosis,Jiangyin Hospital Affiliated to the Medical College of South-East University,Jiangyin 214400,China;Department of the No1 Clinical Medicine,China Medical University,Shenyang 110122 China;Department of Anesthesia and Pain,Zhejiang Provincial People's Hospital,Hangzhou 310014 China;Department of Gynaecology and Obstetrics,Jiangyin Hospital Affiliated to the Medical College of South-East University,Jiangyin 214400,China;Department of Ultrasound Diagnosis,Zhongda Hospital Affiliated to the Medical College of South-East University,Nanjin 210009,China)
出处
《中华解剖与临床杂志》
2021年第1期28-33,共6页
Chinese Journal of Anatomy and Clinics
基金
无锡市卫生健康委员会科技成果与适宜技术推广项目(T202027)
江阴市卫生健康委员会指导性科研项目(G201801)。
关键词
血流动态学
妊娠
仰卧位低血压综合征
超声检查
下腔静脉
脐动脉
子宫动脉
Hemodynamics
Pregnancy
Supine hypotension syndrome
Ultrasonography
Inferior vena cava
Umbilical artery
Uterine artery
