脉冲式多普勒测定胎儿C／P值及其与脐动脉低氧血症的相关？…

研究胎儿大脑中动脉搏动指数（ＰＩＭＣＡ）和脐动脉搏动指数（ＰＩＵＡ）之比（Ｃ／Ｐ）与新生儿脐动脉低氧血症关系，使Ｃ／Ｐ值应用于临床诊断和预测。应用多普勒超声技术，对５２例妊娠晚期妇女进行胎儿ＭＣＡ和ＵＡ血流速度波型检查，将Ｃ／Ｐ值与选择性剖宫产相应新生儿脐动脉血气分析和围产儿结局比较。结果：正常妊娠胎儿Ｃ／Ｐ值为２．０，重度妊高征、过期妊娠及重度胎动异常孕妇胎儿Ｃ／Ｐ值小于１；Ｃ／Ｐ值的降低与新生     

胎儿脐动脉、大脑中动脉及腹主动脉的血流频谱与脐动脉血气相关性的研究

本文对３２例足月单胎正常妊娠拟行择期剖宫产的初孕妇，于术前３０小时内，以彩色超声多普勒测定胎儿脐动脉（ＵＡ），大脑中动脉（ＭＣＡ）及腹主动脉（ＡｂＡｏ）的血流频谱．即血流阻力指数（ＲＩ），搏动指数（ＰＩ），收缩期峰值（Ｓ）与舒张末期值（Ｄ）的比值（Ｓ／Ｄ）。并于剖宫术胎儿娩出后取脐动、静脉血、测定ＰＨ、ＰＣＯ２及ＰＯ２，观察各种动脉血流频谱与脐血血气间相关性。结果表明：ＵＡ—ＲＩ与脐动脉血气ＰＨ、ＰＣＯ２呈显著的负相关（Ｐ＜０．０１及Ｐ＜０．０５），ＭＣＡ—ＲＩ与脐动脉ＰＨ值呈负相关（Ｐ＜０．０５），与ＰＣＯ２呈明显正相关，（Ｐ＜０．０１），ＡｂＡｏ－ＲＩ与脐动脉血气三项虽呈负相关，但不显著（Ｐ＞０．０５）。提示：产前监测ＵＡ及ＭＣＡ血流频谱，可间接了解胎儿的内环境血气及酸碱情况，能及早的诊断胎儿宫内安危状况。     

彩色多普勒血流动力学指标预测胎儿缺氧及酸中毒的价值

目的： 评价血液动力学指标预测胎儿缺氧及酸中毒的价值。方法： 用彩色多普勒超声检测 ５４ 例正常晚 期妊娠 （正常组） 和 ３６ 例高危妊娠 （高危组） 妇女子宫动脉 （ＵｔＡ） 和胎儿脐动脉 （Ｕｍ Ａ）、大脑中动脉（Ｍ ＣＡ）、肾动脉 （ＲＡ） 的血流速度波型 （ＦＶＷ ｓ）, 并且测定高危组脐动脉血气。结果： 高危组ＵｔＡ、Ｕｍ Ａ、ＲＡ 的阻力指数 （ＲＩ） 搏动指数 （ＰＩ） 及收缩期最大血流速度与舒张末期血流速度的比值 （Ｓ／Ｄ） 均高于正常组, 而Ｍ ＣＡ的ＰＩ及Ｓ／Ｄ 值均明显低于正常组 （Ｐ＜ ００５）。与Ｕｍ Ａ 氧分压 （ＰＯ２） ＞ ２５ｋＰａ 的高危妊娠病例比较, Ｕｍ Ａ ＰＯ２＜２５ ｋＰａ 者ＵｔＡ 的Ｓ／Ｄ 值, Ｕｍ Ａ 的ＰＩ, Ｓ／Ｄ 值以及ＲＡ 的ＲＩ、ＰＩ、Ｓ／Ｄ 值均明显增高, Ｍ ＣＡ 的ＰＩ明显降低 （Ｐ＜００５）。Ｕｍ Ａ 及ＲＡ 的ＰＩ与Ｕｍ Ａ ＰＯ２ 的ｐＨ 值呈负相关, 与二氧化碳分压 （ＰＣＯ２） 呈正相关, Ｍ ＣＡ 的ＰＩ与Ｕｍ Ａ的 ｐＨ、ＰＯ２ 呈正相关, 与ＰＣＯ２ 呈负相关。结论： 高危妊娠胎儿缺氧时, Ｍ ＣＡ 血流阻力降低, 而周围血管, 特别是肾血管血流阻力明显升高。胎儿血液动力学变化与缺氧及酸碱平衡失     

彩色多普勒观察高危妊娠时硝酸甘油对胎儿－胎盘血流动力学的影响

本文介绍应用彩色多普勒超声技术观察３０例高危妊娠孕妇口含硝酸甘油前后的脐动脉、胎儿大脑中动脉、胎儿腹主动脉的血流动力学改变。结果：用药后脐动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）和Ｓ／Ｄ值均有显著改变（Ｐ＜０．００１），胎儿大脑中动脉和胎儿腹主动脉的ＰＩ、ＲＩ和Ｓ／Ｄ值无显著变化。而孕妇血压、心率和胎心率未见明显改变，呈现良好的耐受性。表明应用硝酸甘油可明显降低脐－胎盘血管阻力，是改善胎儿血氧供应的简便、有效的方法。而彩色多普勒超声显像则为围产期好高征早期诊断及疗效观察提供了重要的依据。     

羊水过多胎儿血流变化的临床研究

目的探讨羊水过多胎儿血流的变化。方法对１３例足月妊娠羊水过多应用彩色多普勒显像技术（ＣＤＦＩ）检测胎儿肾动脉,大脑中动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）以及脐动脉Ｓ／Ｄ。结果羊水过多胎儿肾动脉ＰＩ、ＲＩ明显高于正常羊水量对照组（Ｐ＜０．０５）;大脑中动脉ＰＩ、ＲＩ,脐动脉Ｓ／Ｄ值两组比较无显差异（Ｐ＞０．０５）。结论羊水过多与胎儿肾动脉血流有明显相关性,其胎儿肾动脉血流阻力改变在羊水过多中的     

彩色多普勒观察高危妊娠时硝酸甘油对胎儿—胎盘血流动力学的影响

本文介绍应用彩色多普勒超声技术观察３０例高危妊娠孕妇口含硝酸甘油前后的脐动脉、胎儿大脑中动脉、胎儿腹主动脉的备注动力学改变。结果：用药后脐动脉的搏动指数（ＰＩ）、阻力指数（ＲＩ）和Ｓ／Ｄ值均有显著改变（Ｐ＜０．００１），胎儿大脑中动脉和胎儿腹主动脉的ＰＩ、ＲＩ和Ｓ／Ｄ值无显著变化。而孕妇血压、心率和心率未见明显改变，呈现良好的耐受性。表明应用硝酸甘油可明显降低脐－胎盘血管阻力；是改善胎儿血氧供应的     

彩色多普勒超声对妊娠晚期胎儿血流检测指标的探讨

彩色多普勒超声对妊娠晚期胎儿血流检测指标的探讨曹喜琴①李长虹汪应先本文对３８８例妊娠晚期的孕妇使用彩色多普勒血流显像（ＣＤＦＩ）技术检测胎儿脐动脉（ＵＡ）、大脑中动脉（ＣＭＡ）、肾动脉（ＫＡ）、胎盘血管床动脉（ＰＡ），并分别测定其搏动指数（ＰＩ）、阻...     

胎羊脐动脉搏动指数的血液动力学机制研究

目的：经胎羊腹主动脉注射微球的方法阻塞胎盘，建立胎儿窘迫的动物模型，研究脐动脉搏动指数（ＰＩ）的血液动力学特点。材料与方法：健康妊娠绵羊（湖羊）８头，于妊娠１１６～１２５天行宫腔内胎儿手术，胎羊股动脉插管，顶端达胎羊腹主动脉水平，脐动脉置电磁流量计探头，检测胎儿腹主动脉血压和脐动脉血流，手术后予以补液、抗炎、抗凝、补充羊水等处理。经胎儿腹主动脉导管注射微球阻塞胎盘（每１５ｍｉｎ一次）。用快速傅里叶转换的方法把血压和血流波形的时域信号转换为输入阻抗的频域图谱，计算脐动脉阻力（Ｒ）、阻抗（Ｚ）和搏动指数（ＰＩ）。结果：微球注射次数与脐动脉阻力的对数之间有明显的相关性（ｒ＝０．６５７９，Ｐ＜０．００１），与脐动脉阻抗之间无明显的相关性（Ｐ＞０．０５），与脐动脉ＰＩ的对数之间有明显的相关性（ｒ＝０．９２２０，Ｐ＜０．００１）。ＰＩ与Ｒ／Ｚ比值有明显的相关性（ｒ＝０．９７４３，Ｐ＜０．００１），明显优于ＰＩ与阻力的相关性（ｒ＝０．９０９１，Ｐ＜０．００１）。结论：脐动脉的ＰＩ不仅反映了阻力的变化，而且间接受阻抗的影响；ＰＩ直接反映了Ｒ／Ｚ比值。     

脉冲多普勒超声对胎儿不同妊周脐带及脑循环动态变化的研究

目的，探讨不同妊周胎儿脐血流及脑血流的变化规律。方法，对４２２例妊娠２１～４２周正常产妇，用脉冲多普勒超声测量其胎儿脐带动脉（ＵＡ）、大脑中动脉（ＭＣＡ）之ＲＩ（阻力指数）与ＰＩ（搏动指数）。结果与结论，ＲＩ与ＰＩ的变化高度一致（ｒ＝０．９７８）（ｐ＜０．００１）。ＵＡ两指数在妊娠２１周时最高，此后逐渐下降至足月（Ｐ＜０．００１）。ＭＣＡ两指数从２１周起先缓慢上升，２９周时达高峰，此后迅速下降至足月（ｐ＜０．００１）。ＵＡ的ＲＩ、ＰＩ与ＭＣＡ的ＲＩ、ＰＩ之比值，从妊娠２１周起迅速下降，２９～３４周间维持较低水平，以后缓慢上升，到妊娠足月时仍明显低于妊娠２１周时水平（Ｐ＜０．００１）。     

多普勒超声评价环孢素对移植肾血流动力学的影响

应用彩色多普勒超声对３８例肾移植术病人口服环孢素Ａ（ＣＳＡ）进行谷浓度和峰浓度的血液动力学研究，将患者分为移植肾功能正常组（ｎ＝２２）和移植肾功能不全组（ｎ＝１６）。在不同的ＣＳＡ水平分别测定肾动脉、段动脉、肾皮质部血管的阻力指数（ＲＩ）、搏动指数（ＰＩ）、最大流速（Ｖｍａｘ）。结果表明：移植肾功能正常组峰浓度时肾皮质部的ＲＩ、ＰＩ、Ｖｍａｘ较谷浓度时明显升高（Ｐ值＜０．０１），而段动脉和肾动脉的上述指标在两种浓度时均无显著差异（Ｐ值＞０．０５）。ＣＳＡ可以导致肾皮质血管的收缩，彩色多普勒超声能较敏感的反映ＣＳＡ的这种效应。     

彩色多普勒超声评价双胎输血综合征受血儿心功能的临床价值

目的探讨彩色多普勒超声评价双胎输血综合征(TTTS)受血儿右心心肌运动功能的临床价值。方法选取16例确诊为TTTS的孕妇为研究对象,应用彩色多普勒测量两组胎儿脐静脉、脐动脉、大脑中动脉、静脉导管、半月瓣、房室瓣的血流频谱、右心心肌做功指数及胎儿心胸面积比值。结果 TTTS受血儿体质量、心胸面积比值、右心心肌做功指数、左心心肌做功指数显著高于供血儿(均P0.05)。TTTS受血儿静脉脉搏动征(PUV)、静脉导管A波缺失或反向(ARDV)、三尖瓣反流(TR)、三尖瓣舒张期血流单峰(ATVI)比率显著高于供血儿,差异有统计学意义(P0.05)。结论彩色多普勒超声能有效评价TTTS受血儿心功能尤其是舒张功能异常,可为TTTS产前诊断提供有效重要的信息。     

彩色多谱勒对IUGR脐动脉血流的检测

目的：应用彩色多谱勒检测正常妊娠和胎儿宫内发育迟缓（以简称ＩＵＧＲ）的脐动脉血流指标ＰＩ、ＲＩ、Ｓ／Ｄ值。材料和方法：应用彩色多谱勒检测了２００例正常妊娠和１１１例ＩＵＧＲ的脐动脉血流,孕周从２６－４１周。结果：正常妊娠组及ＩＵＧＲ组的脐动脉血流指标均随妊娠周数的增高而降低,但ＩＵＧＲ组的脐动脉血流ＰＩ、ＲＩ、Ｓ／Ｄ值明显高于正常妊娠组（Ｐ〈０．０１）。孕３０周后,脐动脉血流Ｓ／Ｄ值〉４,揭示胎儿预后不良。结论：脐动脉血流检测不仅是胎儿监护的一种方法,而且可作为诊断ＩＵＧＲ的一个指标及对估计胎儿预后有一定的临床价值。     

脐带打结的超声诊断及其对胎儿围产期结局的影响

目的 分析超声对脐带打结的产前诊断价值及脐带打结与围产期结局的关系.方法 回顾性分析2015年1月至2019年12月间在安徽医科大学第一附属医院妊娠晚期出生或引产胎儿的产前超声及相关临床资料.总结分析脐带打结发生率及其与围产期结局的关系、产前二维超声和三维超声对脐带打结的诊断价值并归纳其声像图特征;并以产后诊断有脐带打...     

Fetal arterial Doppler studies in twin-twin transfusion syndrome.

This cross-sectional study investigates the circulatory profile of the donor and recipient fetuses in pregnancies with twin-twin transfusion syndrome manifested by acute polyhydramnios during the second trimester of pregnancy. Doppler investigations of the umbilical arteries and of the fetal descending thoracic aortas and middle cerebral arteries were performed in both fetuses of 27 pregnancies with twin-twin transfusion syndrome at 18 to 25 (mean, 21.7) weeks' gestation. Significant differences from normal values were increased umbilical artery pulsatility index and decreased aortic mean velocity in both donor and recipient fetuses, decreased middle cerebral artery pulsatility index in recipients and decreased middle cerebral artery mean velocity in donors. Increased umbilical artery pulsatility index in some donor and recipient fetuses may be the consequence of abnormal placental development and polyhydramnios-related compression, respectively. Doppler findings in the fetal circulation are compatible with hypovolemia in the donor and hypervolemia with congestive heart failure in the recipient.     

Ultrasound assessment of venous blood flow before and after laser therapy: approach to understanding the pathophysiology of twin-twin transfusion syndrome.

OBJECTIVE: To estimate direction and volume of blood exchange between the donor twin and recipient twin by ultrasound assessment of blood flow in the umbilical vein before and after selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS). METHODS: Forty-one TTTS patients underwent Doppler examination of the umbilical vein before and 24 h after SLPCV. The diameter and mean time-averaged velocity of the umbilical vein were estimated. Total umbilical venous flow (TUVF) was calculated as follows: TUVF (mL/min) = mean time-averaged velocity (cm/s) x mean cross-sectional area (cm2) x 60 (s). RESULTS: TUVF was significantly higher in the recipient (111.2 mL/min) than in the donor twin (44.8 mL/min) before SLPCV (P < 0.0001). However, TUVF was no different between the recipient and the donor twin after SLPCV (93.1 vs. 70.7 mL/min, recipient and donor twin, respectively, P = 0.11). The donor twin's TUVF increased after surgery (P < 0.0001), while the recipient twin's TUVF decreased (P = 0.041). The median postoperative increase in the donor twin's TUVF of 25.9 mL/min had a corresponding decrease of TUVF in the recipient twin of 18.1 mL/min (P = 0.27). CONCLUSIONS: Our data suggest that untreated TTTS is characterized by excessive umbilical venous blood flow in the recipient twin relative to the donor twin. Laser surgery results in concordant changes in umbilical venous flow in opposite directions between the donor and recipient twins, eliminating the initial imbalance. Our results lend support to the fundamental hypothesis of unbalanced blood flow exchange (net flow from donor to recipient) between monochorionic twins as the cause for TTTS and that laser surgery eliminates the pathophysiological cause.     

Timely diagnosis of twin-to-twin transfusion syndrome in monochorionic twin pregnancies by biweekly sonography combined with patient instruction to report onset of symptoms.

OBJECTIVES: To assess the value of serial ultrasound examinations together with patient instructions to report the onset of symptoms in achieving timely detection of twin-to-twin transfusion syndrome (TTTS) in a cohort of monochorionic diamniotic twin pregnancies, and to evaluate sonographic TTTS predictors. METHODS: Timely detection of TTTS was defined as diagnosis before severe complications of TTTS occurred, such as preterm prelabor rupture of membranes, very preterm delivery (24-32 weeks of pregnancy), fetal hydrops, or intrauterine fetal death. During a 2-year period, a prospective series of 23 monochorionic twin pregnancies was monitored from the first trimester until delivery. At least every 2 weeks we performed ultrasound and Doppler measurements (nuchal translucency thickness, presence of membrane folding, estimated fetal weight, deepest vertical pocket, bladder filling, and Doppler waveforms of the umbilical artery, ductus venosus and umbilical vein). Measurements of TTTS cases were compared with those of non-TTTS cases matched for gestational age. Furthermore, patients were informed about the symptoms caused by TTTS, and instructed to consult us immediately in case of rapidly increasing abdominal size or premature contractions. RESULTS: In all four TTTS cases, the diagnosis was timely. At the time of diagnosis, one case was at Quintero Stage 1, two at Quintero Stage 2, and one at Quintero Stage 3. Two of the TTTS cases became apparent after the patients' feeling of rapidly increasing girth. The identification of TTTS predictors was successful with respect to one parameter: isolated polyhydramnios in one sac, without oligohydramnios in the other, preceded the ultimate diagnosis of TTTS in two of the four TTTS cases. All other ultrasound measurements of TTTS cases, prior to the diagnosis of TTTS, were within the range of measurements of non-TTTS cases. CONCLUSION: Biweekly ultrasound examinations, with special attention to the amniotic fluid compartments of both fetuses, combined with detailed patient instructions to report the onset of symptoms resulted in timely diagnosis of all TTTS cases and appears to be a safe program for monitoring monochorionic twin pregnancies.     

Correlation of Doppler and placental immunohistochemical features in normal and intrauterine growth-retarded fetuses.

The aim of this study was to correlate and compare Doppler and anatomical placental findings obtained from 48 normal and 35 intrauterine growth-retarded (IUGR) fetuses. The IUGR group consisted of 19 fetuses from pregnancies complicated by pre-eclampsia and 16 from healthy mothers. Color Doppler evaluation of umbilical, spiral and uterine arteries was performed. Placental specimens from both normal and growth-retarded fetuses were obtained at the time of delivery. Placental specimens were evaluated using histochemical and immunohistochemical techniques. A progressive decrease in the pulsatility index was observed in umbilical, spiral and uterine arteries throughout pregnancy in the normal-growth fetuses. High umbilical artery pulsatility index values were obtained in 29 out of the 35 growth-retarded fetuses, six of them showing absent or reversed end-diastolic umbilical artery flow pattern. A total of 13 IUGR fetuses showed high resistance uterine artery flow velocity waveforms. Increased pulsatility index values were obtained from the spiral arteries of 16 growth-retarded fetuses. Abnormal histological and histochemical placental patterns were observed in all the growth-retarded fetuses with umbilical artery Doppler abnormalities. The presence of a peculiar dendritic cell subpopulation, strongly resembling the Langerhans cells, expressing the HLA-DR+/CD1+ phenotype, was detected in all growth-retarded fetuses, whether there was maternal pathology or not. Our data show uterine and spiral artery data as being ineffective in the monitoring of IUGR fetuses. The placental extracellular matrix seems to play an important role in the regulation of the umbilical circulation. The presence of CD1+ cells as a sign of a possible immunological mechanism in the pathogenesis of the intrauterine growth retardation is discussed.     

Instability of Doppler cerebral blood flow in monochorionic twins.

OBJECTIVE: The purpose of this study was to evaluate Doppler flow velocity changes in cerebral vessels of monochorionic twins with twin-twin transfusion syndrome (TTTS). METHODS: Repeated Doppler umbilical and cerebral blood flow studies were performed in 7 twin pairs with TTTS. Eight monochorionic twin pairs and 11 dichorionic twin pairs served as control groups. The following Doppler parameters were assessed: umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio, delta PI between the umbilical artery and MCA, and peak systolic velocity (PSV) in the MCA. RESULTS: Significant variations in PSV in the MCA and cerebral indices were found in the study group of monochorionic twins with TTTS. Periods of high PSV with low PI in the MCA were followed by lower PSV in the same fetus. Repeated measurements in the comparison groups were stable without significant variations. The delta cerebroplacental ratio was significantly higher in the study group (0.38 versus 0.09 and 0.19 in the comparison groups; P < .02). CONCLUSIONS: Significant changes in Doppler flow velocity and indices suggest instability of cerebral blood flow with episodes of "hyperperfusion" in monochorionic twins with TTTS. Further studies are needed to elucidate the relationship of these transient changes to neurologic sequelae in the neonate.     

多普勒超声评分体系在晚孕胎儿监护中的应用及意义

目的评价多普勒超声评分体系(DUPS)在晚孕胎儿监护中的应用价值。方法选择459例孕龄大于32周的孕妇行彩色多普勒超声检查,检测胎儿大脑中动脉搏动指数(MCAPI)、心脏大小、心功能、脐动脉搏动指数(UmAPI)、静脉导管搏动指数(DVPI)及脐静脉血流频谱(UV)。根据上述5项指标计算其DUPS评分,无异常时每项得2分,有异常时得1分或0分。将其评分结果与其围产期结局进行比较和分析。结果459例晚孕胎儿中有402例正常分娩(87.58%),48例因临床上需要而提早终止妊娠(10.46%),9例围产期死亡(1.96%)。正常分娩、提早终止妊娠、围产期死亡组间DUPS评分有显著性差异(P<0.001)。应用受试者工作特性曲线法确定预测围产期结局不良(包括提早终止妊娠和围产期死亡)DUPS评分的最佳诊断界点为8分(灵敏度78.95%,特异度95.52%),预测围产期死亡DUPS评分的最佳诊断界点为6分(灵敏度100.00%,特异度99.11%)。结论DUPS在预测晚孕胎儿的围产期结局不良中具有重要的临床价值,值得进一步研究与应用。     

二维应变成像评价双胎输血综合征受血儿右心功能的初步研究

目的 探讨二维应变成像在评价双胎输血综合征(twin-twin transfusion syndrome,TTTS)受血儿右心功能中的价值.方法 选择TTTS 16例及正常单绒毛膜囊双羊膜囊双胎19例,分别测量两个胎儿脐动脉、脐静脉、静脉导管、大脑中动脉、房室瓣口、半月瓣口等部位的血流频谱参数,计算心肌做功指数.然后局部放大胎儿四腔心,清晰显示心内膜及肌层,动态存储2~3个心动周期,脱机分析两组胎儿右心纵向收缩期峰值应变.结果 TTTS受血儿心胸面积比值、右心心肌做功指数大于供血儿及对照组,差异有统计学意义;TTTS受血儿右心游离壁、室间隔及平均纵向收缩期峰值应变小于供血儿及对照组,差异有统计学意义.结论 二维应变成像可反映TTTS受血儿的右心心肌运动异常,但是在羊水过多及胎动频繁时应用受到限制.

Abstract：

Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.Methods Sixteen TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were included.Doppler studies of the umbilical artery,umbilical vein,ductus venosus,middle cerebral artery,atrioventricular valve and semilunar value were recorded in both fetus,and myocardial performance index of both ventricles was calculated.Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.Results Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls.Right ventricular strain was decreased in recipient fetus compared with controls.Conclusions Two-dimensional strain imaging can be used to evaluate right ventricular myocardial function in the recipient fetus of TTTS.