三维能量彩色多普勒超声用于检测子痫前期孕妇胎盘组织血流灌注的价值

目的 探讨三维能量彩色多普勒超声检测子痫前期孕妇胎盘组织血流灌注的临床价值.方法 选择2007年7月至2008年5月在首都医科大学附属北京妇产医院超声科行产前超声检查的正常孕妇及子痫前期孕妇共80例,其中36例正常孕妇为正常孕妇组,44例子痫前期孕妇分为轻度子痫前期组(9例),重度子痫前期组(26例),慢性高血压合并子痫前期组(慢高合并子痫前期组,9例).应用三维能量彩色多普勒超声仪检测各组孕妇胎盘三维直方图血管指数(VI)、血流指数(FI)、血管化血流指数(VFI),应用二维多普勒超声检测脐血流收缩期/舒张期血流速度峰值(S/D值).并记录分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量.结果 (1)VI、FI、VFI及脐血流S/D值:正常孕妇组分别为6.3±2.9、38.6±4.4、2.7±1.3及2.5±0.6;轻度子痫前期组分别为5.7±3.8、36.3±7.2、2.4±2.0及2.4±0.3;重度子痫前期组分别为3.0±2.4、31.7±5.0、1.1±1.0及2.9±1.3;慢高合并子痫前期组分别为2.2±1.6、26.1±4.4、0.8±0.6及3.1±1.6.正常孕妇组孕妇胎盘VI、FI、VFI值与轻度子痫前期组比较,差异均无统计学意义(P>0.05),而重度子痫前期组和慢高合并子痫前期组孕妇胎盘VI、FI 、VFI兀值均明显低于正常孕妇组(P<0.01)及轻度子痫前期组(P<0.05).而各组孕妇脐血流S/D值相互比较,差异均无统计学意义(P>0.05).(2)分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量:正常孕妇组分别为(38.7±1.5)周、(3280±520)g、3%及(568±141)g;轻度子痫前期组分别为(37.9 ±1.0)周、(2971±265)g.0及(576±98)g;重度子痫前期组分别为(33.2±2.6)周、(1820±737)g.58%及(458±154)g;慢高合并重度子痫前期组分别为(32.6±2.6)周、(1497±533)g.7/9及(396±141)g.正常孕妇组与轻度子痫前期组分娩孕周、新生儿出生体重、低出生体莺儿百分比和胎盘重量比较,差异均无统计学意义(P>0.05),而重度子痫前期组和慢高合并重度子痫前期组的分娩孕周、新生儿出生体重、低出生体重儿百分比和胎盘重量均明显低于正常孕妇组(P<0.01)与轻度子痫前期组(P<0.05).结论 (1)重度子痫前期及慢高合并子痫前期孕妇胎盘组织的血流灌注明显减少,临床上相应出现胎盘重量及新生儿出生体重下降、分娩孕周偏低、低出生体重儿数量增加等结果;而脐血流S/D值无明显变化.(2)三维能量彩色多普勒超声对胎盘组织血流灌注的检测有重要的临床诊断意义.

Investigate of three-dimensional power Doppler ultrasound used in placental perfusion assessment in pre-eclampsia pregnancies

Objective To investigate the placenta perfusion in pre-eclampsia by three-dimensional power Doppler ultrasound and analysing the clinical outcome. Method 80 cases of normal and pre-eclampsia pregnant women from July 2007 to May 2008 in Beijing Obstetrics and Gynecology Hospital were studied. The control group of 36 cases, pre-eclampsia were divided into three groups: a total of 44 cases, mild pre-eclampsia group (9 cases), severe pre-eclampsia group (26 cases) and chronic hypertension with pre-eclampsia group (9 cases). The placental vascular index (VI), flow index (FI), blood vessels and blood flow index (VFI) by three-dimensional Doppler histogram and the umbilical blood flow systolic to diastolic (S/D) by color Doppler flow imaging were calculated and the gestational age after delivery, birth weight, placental weight after birth were recorded respectively. Results (1)VI、 FI、 VFI and umbilical blood flow S/D value :6.3±2.9, 38.6±4.4, 2.7±1.3, 2.5±0.6 in normal group ;5.7±3.8, 36.3±7.2, 2.4±2.0, 2.4±0.3 in mild pre-eclampsia group;3.0±2.4, 31.7±5.0, 1.1±1.0, 2.9±1.3 in severe pre-eclampsia group ;2.2±1.6, 26.1±4.4, 0.8±0.6, 3.1±1.6 in chronic hypertension with pre-eclampsia group. Placenta of normal group and mild preeclampsia group VI, FI, VFI were no significant difference (P>0.05), placental VI, FI, VFI of severe preeclampsia group and chronic hypertension with severe pre-eclampsia group were significantly lower than the normal group (P<0.01) and than mild pre-eclampsia group (P<0.05). The umbilical blood flows were not obvious difference among four groups (P>0.05) ; (2) Gestationul age after birth, birth weight, low newborn weight rate and placental weight:(38.7±1.5 ) weeks, (3280±520) g, 3%, (568±141) g in normal group; (37.9±1.0) weeks, (2971±265) g, 0,(576±98) g in mild pre-eclampsia group; (33.2±2.6) weeks, (1820±737) g,58%, (458±154) g in severe pre-eclampsia group; (32.6±2.6) weeks, (1497±533) g, 7/9, (396±141) g in chronic hypertension with pre-eclampsia group. The normal group and mild pre-eclampsia group in gestationul age after birth, birth weight, low newborn weight rate and placental weight were not significant difference (P>0.05); severe pre-eelampsia and chronic hypertension with severe pre-eclampsia group in them were significantly lower than the normal group (P<0.01) and than mild pre-eclampsia group (P<0.05).Conclusions (1) Placental blood flow perfusion of the severe pre-eclampsia and pre-eclampsia with chronic hypertension of pregnancy decreased resulting in clinically lower placental weight, birth weight and gestational age at delivery, but there were no obvious differences in umbilical blood flow S/D values. (2) The investigation was helpful to clinical diagnosis in the placenta perfusion of pre-eclampsia by three-dimensional power Doppler ultrasound.