廖桂英,段庆红,周舟,石兢恒
LIAO Guiying,DUAN Qinghong,ZHOU Zhou,SHI Jingheng

• 1:贵州医科大学医学影像学院
• 2:贵州医科大学附院影像科
• 3:贵州医科大学附院产前诊断中心超声部

摘要(Abstract)：

目的:探讨彩色超声多普勒检测脐动脉血流动力学在子痫前期诊疗中的价值。方法:将产科35例子痫前期孕妇作为子痫前期组,同期接受健康检查的35例正常妊娠孕妇作为正常妊娠组,行彩色超声多普勒检测,观察2组孕妇脐动脉收缩期峰值时的血流速度(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)、阻力指数(RI)及血流速度峰谷比(S/D),比较2组孕妇脐动脉血流动力学异常发生率。结果:子痫前期组孕妇PSV及EDV低于正常妊娠组,S/D高于正常妊娠组,差异有统计学意义(P<0.05);子痫前期组孕妇脐动脉血流动力学异常发生率高于正常妊娠组,其中孕晚期S/D>3.0、脐动脉舒张期血流消失及RI>0.8的发生率均高于正常妊娠组,差异均有统计学意义(P<0.05)。结论:彩色多普勒监测子痫前期孕妇脐动脉血流动力学指标,对临床干预有一定的参考价值。
Objective: To study the value of color ultrasound doppler detection of umbilical artery hemodynamics in the diagnosis and treatment of preeclampsia. Methods: 35 cases of pre-eclampsia pregnant women in obstetrics department of the affiliated hospital of Guizhou Medical University from January 2018 to December 2018 were selected as the pre-eclampsia group and 35 cases of normal pregnancy pregnant women who received health examination at the same time were selected as the normal pregnancy group. Color doppler detection was performed on the subjects, the hemodynamic parameters of umbilical artery were observed in the two groups and the incidence of abnormal umbilical artery hemodynamics was compared between the two groups. Results: Among the preeclampsia patients, there were 13 cases with loss of fetal umbilical artery diastolic blood flow, accounting for 37.1%, 8 cases with increased S/D, and 5 cases with RI>0.8. However, in the normal group, there were only 2 cases with increased S/D, and no loss of fetal umbilical artery diastolic blood flow was detected. The PSV and EDV of the preeclampsia group were lower than that of the normal group and S/D was higher than that of the normal group, the difference between the two groups was statistically significant(P<0.05). The incidence of abnormal umbilical artery hemodynamics in preeclampsia group was higher than that in the normal pregnancy group, the incidence of S/D>3.0, disappearance of umbilical artery diastolic blood flow and RI>0.8 in the third trimester of pregnancy were all higher than those in the normal pregnancy group, the differences were statistically significant(P<0.05). Conclusion: The incidence of abnormal umbilical arterial blood flow in preeclampsia group was higher than that in normal group. The application of color doppler flow imaging in the detection of fetal umbilical artery blood flow dynamics in preeclampsia can provide some reference value for clinical intervention.

关键词(KeyWords)： 超声,彩色,多普勒;子痫前期;胎儿;脐动脉;血流动力学
ultrasound,color,doppler;preeclampsia;fetus;umbilical artery;hemodynamics

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅联合基金项目[黔科合LH字(2015)7421]

作者(Author): 廖桂英,段庆红,周舟,石兢恒
LIAO Guiying,DUAN Qinghong,ZHOU Zhou,SHI Jingheng

DOI: 10.19367/j.cnki.1000-2707.2019.12.017

参考文献(References)：

• [1] SALEEM S,MCCLURE M,GOUDAR S S,et al.A prospective study of maternal,fetal and neonatal deaths in low- and middle-income countries[J].Bull World Health Organ,2014,92(8):605-612.
• [2] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):721-728.
• [3] MOLB W J,ROBERTS C T,THANGARATINAM S,et al.Pre-eclampsia[J].Lancet,2016,42(3):999-1011.
• [4] ROBERTS J M,HUBEL C A.The two stage model of preeclampsia:variations on the theme[J].Placenta,2009,30(Sup A):32-37.
• [5] PHIPPS E,PRASANNA D,BRIMA W,et al.Preeclampsia:updates in pathogenesis,definitions,and guidelines[J].Clinical Journal of the American Society of Nephrology,2016,11(6):1102.
• [6] FISHER S J.Why is placentation abnormal in preeclampsia[J].American Journal of Obstetrics & Gynecology,2015,213(4):115-122.
• [7] SATOMUR A,SHIGE O.Ultrasonic doppler method for the inspection of cardiac functions[J].The Journal of the Acoustical Society of America,1957,11(29):1181-1185.
• [8] 廖桂英.子痫前期患者胎儿脐动脉与大脑中动脉多普勒参数的变化及其临床价值[D].贵阳:贵州医科大学,2019.
• [9] 谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018.
• [10]李胜利,罗国阳.胎儿畸形产前超声诊断学[M].2版.科学出版社,2017.
• [11]DOUBILEE P M,BENSON C B.妇产科超声图谱[M].陈铁福,孙倩,刘迪雯,译.天津:天津科技翻译出版公司,2005.
• [12]CUNNINGHAM F G.产科学[M].段涛,译.21版.济南:山东科学技术出版社,2006.
• [13]李笑天.子痫前期发病机制的多源性[J].中华围产医学杂志,2015,18(6):407-410.
• [14]REDMAN C W.Hypertension in pregnancy:the NICE guidelines[J].Heart,2011,97(23):1967-1969.
• [15]谢青贞,漆倩荣,徐望明.子痫前期的病理生理研究进展[J].中华妇产科杂志,2015,50(12):949-953.
• [16]ALLEN R E,ROGOZINSKA E,CLEVERLY K,et al.Abnormal blood biomarkers in early pregnancy are associated with preeclampsia:a meta-analysis[J].European Journal of Obstetrics & Gynecology,2014,182:194-201.
• [17]POON L C Y,KAMETAS N A,NEREA M,et al.First-trimester prediction of hypertensive disorders in pregnancy[J].Hypertension,2009,53(5):812-819.
• [18]彭静,柳杨.正常妊娠妇女和HDP孕妇妊娠早、中、晚期子宫动脉及其胎儿脐动脉血流动态变化的比较[J].医学综述,2016,22(10):1996-1998.
• [19]林建华,梁阿娟,林其德,等.正常妊娠和妊娠期高血压疾病孕妇子宫动脉及其胎儿脐动脉血流动态变化规律的多中心研究[J].中华妇产科杂志,2010,45(8):583-587.
• [20]玛丽帕提·马尔旦,杨慧霞,时春艳.胎儿脐动脉舒张末期血流缺失22例分析及妊娠结局[J].中国妇产科临床杂志,2014,15(2):114-117.
• [21]周莉,范玲.脐动脉舒张末期血流缺失35例的分娩时机及处理方案[J].中华围产医学杂志,2012,15(4):228-233.
• [22]张庆英,程海东.子痫前期并发胎儿脐动脉舒张末期血流缺失及返流的母婴结局[J].中国临床医学,2015,(2):207-210.
• [23]秦艳.脐动脉舒张期血流消失时胎儿生长发育及出生情况分析[J].重庆医学,2015,(15):2053-2054.

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