彩色多普勒超声监测药物流产前后子宫血流变化及其机制探讨

目的　探讨药物流产前后子宫血流的变化及药理作用机制。方法　 1999年 6月至 2 0 0 2年 2月应用彩色多普勒 (CDFI)对 5 8例药物流产患者子宫动脉和滋养层动脉进行检测 ,比较用药前后子宫动脉和滋养层动脉的血流变化 ,同时比较药物流产组与对照组血清NO-2 /NO-3 水平。结果　服药后比服药前子宫动脉和滋养层动脉的阻力指数 (RI)、收缩期与舒张期血流速度比值 (S/D)增高 ,血流峰值速度 (Vmax)和血流量 (PBF)明显减低 ,差异有显著性意义 (P <0 0 5 ) ;孕妇血清NO-2 /NO-3 水平比非孕妇女显著增高 ,服药后比服药前降低 ,差异有非常显著性意义 (P <0 0 1) ;病理检查显示 :药物流产后的蜕膜和绒毛细胞变性 ,其血管内皮细胞向管腔内突起 ,基底膜中断。结论　应用CDFI监测子宫血流变化与药理作用和病理检查结果相符 ,可作为临床观察药物流产效果的可靠手段。

Color Doppler imaging in monitoring the uterine blood flow before and after medical abortion

Objective To detect the relationship between the uterine blood flow changes before and after medical abortion and the pharmaceutical mechanism.Methods The uterine and trophospongi arteries of 58 cases receiving medical abortion were detected by color Doppler flow imaging(CDFI) from June 1999 to February 2002.The blood flow changes of the two arteries before and after medication and the serum NO - 2/NO - 3 ratio in the study group and the controls were compared.Results After medication,the resistance index(RI) and blood flow speed ratio of systolic period to diastolic period(S/D) of the uterus and trophospongia arteries were increased and the Vmax and peripheral blood flow(PBF) decreased significantly(P<0.05).The serum NO - 2/ NO - 3 ratio of the pregnant was higher than that of the non-pregnant;after medical therapy it decreased.There was significant difference between them (P<0.01).Pathological examination showed degenerated decidna and chorion,vascular endothelia protrusion and basilar membranes sliting after medication.Conclusion The uterine blood flow changes monitored by CDFI are in accordance with the pharmacological mechanism and pathological findings.It is useful for investigating the efficacy of medical abortion.