本文關鍵詞：彩色多普勒超聲評價臍繞頸胎兒血流動力學與圍生兒臨床結局　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 彩色多普勒超聲 臍帶繞頸 胎兒 血流動力學 圍生兒

【摘要】：目的:探討臍繞頸胎兒臍動脈及大腦中動脈的血流動力學變化,判定圍產(chǎn)兒預后狀況,評價彩色多普勒血流顯像技術在預測胎兒宮內(nèi)缺氧及圍生兒臨床結局方面的使用價值。方法:選取2016年5月至2016年12月就診于山西大醫(yī)院,在我院產(chǎn)前檢查并經(jīng)超聲證實的臍繞頸、單胎、頭位胎兒的孕婦作為觀察對象,以孕周在37~41+6周,我院收治的97例臍帶繞頸胎兒為研究對象,通過彩色多普勒超聲檢查證實其胎兒臍帶繞頸,隨后進行無應激試驗,根據(jù)胎心監(jiān)護判斷缺氧與否進行分組,其結果顯示非缺氧有59例,缺氧有38例,然后測量臍動脈與大腦中動脈血流動力學指數(shù)(RI、PI、S/D),并追蹤產(chǎn)后羊水性狀、試產(chǎn)過程中胎心率變化及分娩方式等。結果:缺氧組臍動脈血流動力學指數(shù)明顯高于非缺氧組,而大腦中動脈血流動力學指數(shù)明顯低于非缺氧組,差異具有統(tǒng)計學意義(P0.05)。缺氧組臍動脈收縮期峰值血流速度與舒張末期血流速度之比(S/D)為(3.24±0.04)、臍動脈血流阻力指數(shù)(RI)為(0.77±0.06)、臍動脈搏動指數(shù)(PI)為(1.70±1.71),大腦中動脈的S/D為(3.28±0.18)、大腦中動脈阻力指數(shù)(RI)為(0.60±0.04)、大腦中動脈搏動指數(shù)(PI)為(1.49±0.10),羊水污染率47.36%(18/38),陰道試產(chǎn)胎心異常率55.26%(21/38),剖宮產(chǎn)率42.10%(16/38);非缺氧組臍動脈收縮期峰值血流速度與舒張末期血流速度之比(S/D)為(2.27±0.07)、臍動脈阻力指數(shù)(RI)為(0.51±0.04)、臍動脈搏動指數(shù)(PI)為(1.10±0.33),大腦中動脈S/D為(4.78±0.14)、大腦中動脈阻力指數(shù)(RI)為(0.82±0.03)、大腦中動脈搏動指數(shù)(PI)為(1.75±0.03),羊水污染率18.64%(11/59),陰道試產(chǎn)胎心異常率22.03%(13/59),剖宮產(chǎn)率15.25%(9/59),二者差異均有統(tǒng)計學意義(均P0.05)。結論:1.臍繞頸胎兒UA-S/D、UA-RI、UA-PI、MCA-RI、MCA-S/D、MCA-PI及羊水污染對于評價胎兒宮內(nèi)安危狀況以及新生兒出生時情況具有臨床參考價值。2.彩色多普勒超聲在檢查臍繞頸胎兒血流變化情況方面敏感、簡單、安全,且其提供的信息準確、豐富,可以為臨床醫(yī)師對患者的進一步診治及預防提供定量依據(jù)。3.及時合理利用彩色多普勒超聲對臍繞頸胎兒大腦中動脈及臍動脈血流情況進行聯(lián)合監(jiān)測,可以更全面、客觀的評價胎兒宮內(nèi)情況,從而更好的服務于臨床。
[Abstract]:Objective: to investigate the hemodynamic changes of umbilical artery and middle cerebral artery (MCA) in fetuses around umbilical neck and to determine the prognosis of perinatal infants. To evaluate the value of color Doppler flow imaging (CDFI) in predicting fetal anoxia and perinatal clinical outcome. Methods: selected from May 2016 to December 2016 in Shanxi Hospital. The pregnant women with umbilical cord around neck, single fetus and head fetus confirmed by ultrasound before prenatal examination in our hospital were studied. 97 cases of umbilical cord around neck fetus were treated in our hospital at 37 ~ 466 weeks of gestation. The fetal umbilical cord around the neck was confirmed by color Doppler ultrasound, and then no stress test was carried out. According to fetal heart monitoring, the fetal umbilical cord was divided into groups. The results showed that there were 59 cases of non-hypoxia and 38 cases of hypoxia. The hemodynamic index of umbilical artery and middle cerebral artery (MCA) was measured, and the characteristics of postpartum amniotic fluid were tracked. Results: the umbilical artery hemodynamic index of hypoxia group was significantly higher than that of non-hypoxia group, while the hemodynamic index of middle cerebral artery was significantly lower than that of non-hypoxia group. The ratio of peak systolic velocity to end-diastolic velocity of umbilical artery in hypoxia group was 3.24 鹵0.04). The umbilical artery resistance index (RI) was 0.77 鹵0.06m, and the umbilical artery pulsatility index (Pi) was 1.70 鹵1.71). The S / D of the middle cerebral artery was 3.28 鹵0.18, and the resistance index of the middle cerebral artery was 0.60 鹵0.04). The pulsatile index of middle cerebral artery (Pi) was 1.49 鹵0.10m, the amniotic fluid contamination rate was 47.36 and 18 / 38, and the abnormal rate of vaginal fetal heart was 55.26 / 38). The cesarean section rate was 42.10% or 16 / 38%; In the non-hypoxia group, the ratio of peak systolic velocity to end-diastolic velocity was 2.27 鹵0.07, and the umbilical artery resistance index (RI) was 0.51 鹵0.04). The pulsatile index of umbilical artery was 1.10 鹵0.33 and the S / D of middle cerebral artery was 4.78 鹵0.14). The resistance index of middle cerebral artery (Ri) was 0.82 鹵0.03 and the pulsatile index of middle cerebral artery was 1.75 鹵0.03). The amniotic fluid contamination rate was 18.64%, the abnormal rate of vaginal fetal heart was 22.03%, the cesarean section rate was 15.25% 9 / 59). There were significant differences between the two groups (P 0.05). Conclusion: 1. UA-S / D UA-RIV UA-RI UA-PII MCA-RIN MCA-Sr D around the cervix of umbilical cord fetus. MCA-PI and amniotic fluid contamination have clinical reference value in evaluating fetal intrauterine safety and neonatal condition. 2. Color Doppler ultrasound is sensitive in detecting fetal blood flow around umbilical neck. Simple, safe, and it provides accurate and rich information. It can provide quantitative basis for further diagnosis, treatment and prevention of patients. 3. Timely and reasonable use of color Doppler ultrasound to umbilical around the neck fetal middle cerebral artery and umbilical artery blood flow monitoring. More comprehensive and objective evaluation of fetal intrauterine conditions, so as to better serve the clinical.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R714.5

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