子宫动脉舒张早期切迹指数预测妊娠期高血压疾病的临床价值

目的:探讨子宫动脉舒张早期切迹指数对妊娠期高血压疾病(PIH)发生的预测价值。方法:选取产前检查并分娩的正常单胎孕妇204例,使用彩色多普勒超声检测2侧子宫动脉,根据有无子宫动脉舒张早期切迹分为有切迹组(21例)和无切迹组(183例),计算切迹指数(NI),量化分为4级,比较各级PIH的发生率及妊娠结局。结果:204例孕妇中188例妊娠期间血压正常,16例发展为PIH。有切迹组孕妇PIH发生率为28.6%,无切迹组为5.5%,差异有统计学意义(P<0.01)。NI 1级组PIH发生率为5.4%,NI 2级组为10.0%,NI 3级组为2/6,NI 4级组为3/4;NI 4级孕妇PIH的发生率均高于NI 1级组和NI 2级组(P<0.01)。NI 4级组孕妇剖宫产率、NI 3级组和NI 4级组新生儿1 min Apgar评分<7分发生率均高于NI 1级组(P<0.05～P<0.01),而NI 3和NI 4级组胎盘质量与NI 2～4级组新生儿体质量均低于NI 1级组(P<0.05～P<0.01)。结论:子宫动脉舒张早期切迹对预测PIH发生有很高的临床指导价值,NI分级法能更好地评估PIH,值得临床推广。

The clinical value of early diastolic notch index of uterine artery in predicting hypertensive disorders complicating pregnancy

Objective:To explore the value of the early diastolic notch index of uterine artery in predicting hypertensive disorders complicating pregnancy( PIH) . Methods:The bilateral uterine arteries in 204 single fetal pregnant women with normal delivery were detected using color doppler ultrasound. The women were divided into the notch group(21 cases) and non-notch group(183 cases) according to the notch in early diastolic uterine artery. The notch index(NI) in all cases were calculated,which was divided into 4 grades. The incidence of PIH and pregnancy outcome of each grade were compared. Results:Among 204 pregnant women,normal blood pressure in 188 cases and developing to PIH in 16 cases were found. The incidences of PIH in notch group and non-notch group were 28. 6% and 5. 5%,respectively,the difference of which was statistically significant(P<0. 01). The incidences of PIH in NI 1 grade,NI 2 grade,NI 3 grade and NI 4 grade women were 5. 4%,10. 0%,2/6 and 3/4,respectively. The incidence of PIH in NI 4 grade women was higher than that in NI 1 grade and NI 2 grade women(P<0. 01). The cesarean section rate in NI 4 group and incidence of neonatal 1 min Apgar score less than 7 in NI 3 and NI 4 group were higher than those in NI 1 group(P<0. 05 to P<0. 01). The placental weight of NI 3 and NI 4 group and newborn body quality in NI 2,3 and 4 group were lower than those in NI 1 group(P<0. 05 to P<0. 01). Conclusions:Early diastolic notch of uterine artery has high clinical value in predicting PIH. The classification of NI can well evaluate the incidence of PIH,which is worthy to be popularized.