彩超监测脐动脉与子宫螺旋动脉对高危妊娠的研究

目的：通过彩色多普勒超声联合监测晚孕期高危妊娠患者胎儿脐动脉（UA）及子宫螺旋动脉（SA）血流参数指标，探讨晚孕期高危妊娠胎儿脐动脉、子宫螺旋动脉血流动力学的变化，以及两者联合监测对预测围产儿结局的临床应用价值。方法应用彩色多普勒超声对120例单胎晚期妊娠妇女胎儿的脐动脉及母体子宫螺旋动脉的血流进行检测，分别测量以下血流参数：收缩期峰值速度与舒张期末速度之比值（S/D），阻力指数（RI）及搏动指数（pulsatility index，PI），80例高危妊娠与40例正常妊娠组作对照分析。结果（1）高危妊娠组胎儿脐动脉及子宫螺旋动脉血流S/D、RI、PI值高于正常妊娠组，差异有统计学意义（P＜0.05）；（2）高危妊娠组围产儿结局异常的百分比明显高于正常妊娠组，差异有统计学意义（P＜0.05）；（3）当胎儿脐动脉和子宫螺旋动脉血流参数指标都异常时，围产儿结局不良发生率为80.00%，明显高于胎儿脐动脉或子宫螺旋动脉单独异常组，且各组间比较差异均有统计学意义（P＜0.05）。结论妊娠晚期彩色多普勒超声检测胎儿脐动脉、子宫螺旋动脉的血流状态，对预测妊娠结局的发生有临床价值；两者联合检测比单纯胎儿脐动脉或子宫螺旋动脉监测对预测高危妊娠胎儿不良结局更有价值；子宫螺旋动脉可以作为脐动脉预测不良妊娠结局的补充。

Study of color doppler ultrasound used in monitoring umbilical artery and uterine spiral artery in high risk pregnancy

Objective To monitor the blood stream parameter indices of the fetal umbilical artery（UA） and uterine spiral artery（SA） of the patients with late gestation high risk pregnancy through the color doppler ultrasound and explore the hemodynamic changes of fetal UA and uterine SA of the patients with late gestation high risk pregnancy and the clinical application value of joint monitoring of the two arteries in predicting the perinatal infants＆#39; outcomes. Methods The color doppler ultrasound was used to detect the blood stream of fetal UA and uterine SA of 120 patients with single birth late pregnancy and the following blood stream parameters were measured： peak systolic velocity/end diastolic velocity（S/D）, resistance index（RI） and pulsatility index（PI）. Eighty patients with high risk pregnancy and 40 patients with normal pregnancy served as the control group. Results （1）The high risk pregnancy group was higher than the normal pregnancy group in the blood stream S/D, RI and PI values of fetal UA and uterine SA, with statistically significant differences（P 〈 0.05）; （2）The high risk pregnancy group was significantly higher than the normal pregnancy group in the percentage of abnormal perinatal outcomes, with statistically significant differences（P〈0.05）; （3）When the hemodynamic parameter indices of both fetal UA and uterine SA were abnormal,the incidence of adverse perinatal outcomes was 80.00%, which was significantly higher than that of the single abnormal fetal UA group or the single abnormal uterine SA group, with statistically significant difference between each group（P〈0.05）. Conclusion The application of color doppler ultrasound in detecting the blood stream status of fetal UA and uterine SA of late pregnancy has clinical value for predicting pregnancy outcomes;Joint monitoring of the two arteries has higher value than single monitoring of fetal UA or single monitoring of uterine SA for predicting adverse outcomes of high risk pregnancy fetuses. Uterine SA can serve as a supplement of fetal UA in predicting adverse pregnancy outcomes.