彩色多普勒超声在宫内胎儿生长受限诊断中的应用价值

目的:探讨应用彩色多普勒超声监测孕妇及胎儿血流参数用于评估胎儿生长受限(FGR)及判断其妊娠预后的价值。方法:常规超声检查可疑的24例FGR孕妇应用彩色多普勒超声进一步评估,测量孕妇子宫动脉、胎儿心率、胎儿动脉系统(脐动脉、大脑中动脉)及胎儿静脉系统血流(下腔静脉、静脉导管及脐静脉),分析其频谱形态及测量血流动力学参数RI及S/D值。并应用静脉系统频谱异常改变作为胎儿分娩的指标之一。研究对象均做脐带抽血检验,随访至妊娠结束。结果:24例FGR均出现血流动力学的改变,其中有6例孕妇子宫动脉频谱舒张早期出现切迹并阻力指数增高。所有的胎儿均出现脐动脉阻力指数增高甚至舒张期血流反向及胎儿大脑中动脉阻力降低。4例胎儿静脉系统频谱异常。结论:应用彩色多普勒超声监测FGR孕妇及胎儿血流动力学变化,可了解胎儿心血管内环境稳态与否,可判断胎儿有无宫内缺氧状况。而静脉系统频谱出现异常可作为胎儿分娩时机的一个指标。

Application value of color Doppler ultrasound to the diagnosis of fetal growth restriction

Objective: To discuss the value in applying color Doppler ultrasound to monitoring maternal and fetal blood flow parameters for the assessment of fetal growth restriction(FGR) and the estimation of the prognosis of pregnancy.Methods: Further evaluation of the 24 cases suspected to be FGR pregnancies by regular ultrasound were conducted by color Doppler.The uterine arteries,fetal heart rates,fetal arterial systems(umbilical arteries,middle cerebral arteries) and the fetal venous system flows(inferior vena cavas,venous and umbilical veins) of the pregnant women were all measured and their RI and S/D were analyzed.And the abnormal changes of venous system of spectrum were used as one of the indicators of fetal childbirth.All the subjects were performed cord blood tests and follow-up observations till the end of pregnancy.Results: Haemodynamics changed in 24 cases with FGR,including 6 cases of pregnant women whose uterine arteries appeared diastolic notch spectrum in the early stage and the resistance index increased.All fetuses showed the increase of the umbilical artery resistance index,even the reverse of diastolic flow and the reduce of fetal middle cerebral artery resistance.And 4 cases showed abnormalities of fetal venous system spectrum.Conclusion: The application of color Doppler ultrasound to monitoring the maternal and fetal hemodynamic changes can find out whether the fetal cardiovascular homeostasis are stable or not and also can judge whether it lacks oxygen or not in the uteruses.And the abnormal venous system spectrum can be regarded as an indicator of fetal delivery time.