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    超声对高危妊娠胎儿静脉导管血流动力学评价及对宫内缺氧的预测

    Evaluation of fetal ductus venosus hemodynamics and prediction of intrauterine hypoxia by ultrasound in high-risk pregnancies

      摘要
    • 摘要:
      目的 利用超声评价高危妊娠胎儿静脉导管(DV)血流动力学，并分析其对宫内缺氧的预测效果，为改善高危妊娠的妊娠结局提供参考。
      方法 选取103例高危妊娠孕妇为观察组，另选取60例正常妊娠孕妇为对照组，采用超声监测胎儿DV血流动力学，对比不同孕期DV血流动力学参数静脉峰值流速指数(PVIV)、平均峰值流速(TAmax)、静脉前负荷指数(PLI)、搏动指数(PI)，分析DV血流动力学参数与孕期的关系；根据胎儿是否宫内缺氧，分为缺氧组、未缺氧组，并依据Apgar评分分为轻度缺氧、重度缺氧，比较缺氧组(轻度缺氧、重度缺氧)、未缺氧组DV血流动力学参数，以受试者工作特征(ROC)曲线分析DV血流动力学参数对宫内缺氧的预测，并进行宫内缺氧的危险度分析。
      结果 孕中期和孕晚期观察组TAmax均小于对照组(P < 0.01)，PI、PLI、PVIV大于对照组(P < 0.01)；在孕中期和孕晚期，TAmax水平在重度缺氧组、轻度缺氧组和未缺氧组3组间均呈递降趋势(P < 0.01)，而PI、PLI和PVIV在3组间均呈递升趋势(P < 0.01)；孕中期、孕晚期TAmax与胎儿宫内缺氧程度均呈负相关关系(P < 0.05)，PI、PLI、PVIV与胎儿宫内缺氧程度均呈正相关关系(P < 0.05)；孕中期、孕晚期TAmax、PI、PLI、PVIV联合预测胎儿宫内缺氧的AUC分别为0.910、0.934(P < 0.05)；分析孕晚期胎儿宫内缺氧危险度，TAmax、PI、PLI、PVIV所致R2值分别为0.094、6.017、5.083、7.561。
      结论 超声检测高危妊娠胎儿DV血流动力学参数评价可反映胎儿宫内缺氧状况，及时发现血流频谱异常并干预处理，减少不良妊娠结局。

       

      Abstract:
      Objective To evaluate the hemodynamics of ductus venosus (DV) in high-risk pregnancies by ultrasound, and to analyze its prediction of intrauterine hypoxia, so as to provide reference for improving the pregnancy outcome of high-risk pregnancies.
      Methods A total of 103 patients with high-risk pregnancy were selected as the study group, and 60 normal pregnant women were selected as the control group.The fetal DV hemodynamics was monitored by ultrasound.DV hemodynamic parameters peak venous velocity index (PVIV), average peak venous velocity (TAmax), venous preload index (PLI), pulse index (PI) during different trimesters were compared to analyze the relationship between DV hemodynamic parameters and pregnancy.According to whether the fetus had intrauterine hypoxia, patients were divided into hypoxia group and non-hypoxia group, and were further divided into mild hypoxia group and severe hypoxia group according to Apgar score.DV hemodynamic parameters of hypoxia group (mild hypoxia, severe hypoxia) and non-hypoxia group were compared, the prediction of DV hemodynamic parameters on intrauterine hypoxia was analyzed by receiver operating characteristic (ROC) curve, and the risk of intrauterine hypoxia was analyzed.
      Results In the second and third trimesters, the TAmax of the study group was lower than that of the control group (P < 0.01), while the PI, PLI, and PVIV were higher than those of the control group (P < 0.01).During the second and third trimesters, TAmax levels showed a decreasing trend among the severe hypoxia group, mild hypoxia group, and non-hypoxia group (P < 0.01), while PI, PLI, and PVIV showed an increasing trend among the three groups (P < 0.01).TAmax in the second and third trimesters were negatively correlated with the degree of intrauterine hypoxia (P < 0.05), PI, PLI, PVIV were positively correlated with the degree of intrauterine hypoxia (P < 0.05).The AUC of combination of TAmax, PI, PLI and PVIV to predict intrauterine hypoxia in the second and third trimesters were 0.910 and 0.934, respectively (P < 0.05).The risk of intrauterine hypoxia in third trimester was analyzed.The R2 values caused by TAmax, PI, PLI and PVIV were 0.094, 6.017, 5.083, 7.561, respectively.
      Conclusions The evaluation of DV hemodynamic parameters in high-risk pregnancies can reflect the fetal intrauterine hypoxia in utero, detect the abnormal blood flow spectrum in time and intervene to reduce the adverse pregnancy outcome.

       

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