本文選題：孕晚期　切入點(diǎn)：胎兒生長(zhǎng)受限　出處：《江蘇大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:胎兒生長(zhǎng)受限是圍產(chǎn)期常見(jiàn)并發(fā)癥之一,此類新生兒即使存活其兒童期體格發(fā)育也較正常兒緩慢,并可能伴有智力發(fā)育低下。彩色多普勒血流影像技術(shù)(CDFI)應(yīng)用于產(chǎn)科可更方便的獲取FGR胎兒循環(huán)信息,其在評(píng)估胎兒生長(zhǎng)受限及判斷其妊娠預(yù)后的價(jià)值也獲得了臨床醫(yī)生的重視和認(rèn)可,其中孕晚期超聲可通過(guò)監(jiān)測(cè)血流參數(shù)確定是否出現(xiàn)胎兒宮內(nèi)缺氧并了解其嚴(yán)重程度,進(jìn)而為臨床是否終止妊娠提供有效依據(jù)。目的:探討應(yīng)用彩色多普勒超聲評(píng)估孕晚期孕婦胎兒臍動(dòng)脈、大腦中動(dòng)脈和主動(dòng)脈弓峽部血流參數(shù)在評(píng)估胎兒生長(zhǎng)受限及判斷妊娠結(jié)局中的臨床價(jià)值。方法:選取在我院產(chǎn)科行超聲檢查的孕晚期孕婦180例。其中臨床診斷為胎兒宮內(nèi)生長(zhǎng)受限的胎兒52例,將其設(shè)為FGR組。經(jīng)臨床常規(guī)檢查診斷無(wú)異常128例,將其設(shè)為對(duì)照組。兩組孕婦均孕34~36周。采用彩色多普勒超聲檢測(cè)胎兒臍動(dòng)脈(UA)和大腦中動(dòng)脈(MCA),測(cè)量收縮期峰值流速(PSV)、舒張期末流速(EDV)、搏動(dòng)指數(shù)(PI)、阻力指數(shù)(RI)和PSV/EDV(S/D)值。檢測(cè)主動(dòng)脈弓峽部(Aol),測(cè)量Aol的收縮期峰值流速PSV以及收縮末反流流速(ESRV)。對(duì)兩組妊娠結(jié)局情況進(jìn)行隨訪,比較兩組胎兒臍動(dòng)脈、大腦中動(dòng)脈和主動(dòng)脈峽部血流參數(shù)值差異。評(píng)價(jià)臍動(dòng)脈、大腦中動(dòng)脈和主動(dòng)脈弓峽部的血流參數(shù)診斷胎兒宮內(nèi)生長(zhǎng)受限及判斷妊娠結(jié)局的價(jià)值。結(jié)果:FGR組圍生期異常妊娠結(jié)局發(fā)生率明顯高于對(duì)照組(P0.01)。FGR組UA S/D、PI、RI的參數(shù)均與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),PSV值比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組MCA S/D、PI、RI的參數(shù)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),PSV無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組胎兒主動(dòng)脈峽部(Aol)ESRV有統(tǒng)計(jì)學(xué)意義,但組間PSV值比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),FGR組ESRV值高于同孕期對(duì)照組,比較有統(tǒng)計(jì)學(xué)差異(P0.05)。將UA和MCA的S/D、RI、PI值以及Ao I的ESRV作ROC曲線分析,各指標(biāo)都具有鑒別對(duì)照組和FGR組的能力,并以ROC曲線結(jié)果得出最佳診斷值,分別以UA-RI=0.66(敏感度=0.90;特異性=0.75)、MCA-RI=0.69(敏感度=0.88;特異性=0.77)和Ao I-ESRV=35.5(敏感度=0.85;特異性=0.94)分別將FGR組患者分組成高低表達(dá)組(UA-RI高vs UA-RI低;MCA-RI高vs MCA-RI低以及Ao I-ESRV高vsAo I-ESRV低),分析FGR孕婦中各高低組發(fā)生宮內(nèi)缺氧程度和預(yù)測(cè)妊娠結(jié)局價(jià)值比較,MCA-RI高低組和Ao I-ESRV高低組輕重缺氧程度組間比較差異有統(tǒng)計(jì)學(xué)意義,UA-RI組無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:孕晚期臍動(dòng)脈以及大腦中動(dòng)脈S/D、RI、PI值和主動(dòng)脈弓峽部ESRV均為評(píng)價(jià)FGR的敏感指標(biāo);通過(guò)分析臍動(dòng)脈、大腦中動(dòng)脈、主動(dòng)脈弓峽部血流參數(shù)診斷胎兒生長(zhǎng)發(fā)育受限能進(jìn)一步明確缺氧程度,具有重要的臨床應(yīng)用價(jià)值。
[Abstract]:Background: fetal growth restriction is one of the common complications during perinatal period. Even if these newborns survive their childhood physical development is slower than normal infants. Color Doppler flow imaging (CDFI) can be used in obstetrics to obtain fetal circulation information of FGR more easily. Its value in evaluating fetal growth restriction and judging the prognosis of pregnancy has also been valued and recognized by clinicians. In the third trimester, ultrasound can determine whether fetal intrauterine hypoxia occurs and understand its severity by monitoring blood flow parameters. Objective: to evaluate the fetal umbilical artery of late pregnant women by color Doppler ultrasound (CDFI). The clinical value of blood flow parameters of middle cerebral artery and aortic arch isthmus in the evaluation of fetal growth restriction and the outcome of pregnancy. Methods: 180 cases of late pregnancy who underwent ultrasonography in our hospital were selected. 52 fetuses with intrauterine growth restriction, The patients were divided into FGR group and no abnormal cases were diagnosed by routine clinical examination. The pregnant women in both groups were assigned to the control group. The fetal umbilical artery (UAA) and MCAA were detected by color Doppler ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (Pi), resistance index (RI) and PSV / EDV / Sr / D were measured. The peak systolic velocity (PSV) and end-systolic reflux velocity (PSV) of Aol were measured. To compare the blood flow parameters of fetal umbilical artery, middle cerebral artery and aortic isthmus between the two groups. The value of blood flow parameters of middle cerebral artery and aortic arch isthmus in diagnosing fetal intrauterine growth restriction and predicting pregnancy outcome results the incidence of perinatal abnormal pregnancy outcome in the FGR group was significantly higher than that in the control group (P 0.01). There was no significant difference in PSV between the two groups (P 0.05). There was no significant difference in the parameters of MCA S / D ~ (I) I RI between the two groups. There was no significant difference between the two groups (P = 0.05). There was no significant difference between the two groups (P > 0.05). There was a significant difference between the two groups in the fetal aorta isthmus (Aol) ESRV, and there was no significant difference between the two groups (P < 0.05). However, there was no significant difference in PSV between the two groups. The ESRV values of the two groups were higher than those of the control group during pregnancy, and the difference was significant (P 0.05). The analysis of ROC curve between UA and MCA and the ESRV of ao I showed that each index had the ability to differentiate between the control group and the FGR group. The best diagnostic value was obtained from the results of ROC curve. UA-RIV 0.66 (sensitivity 0.90; specificity 0.75; MCA-RIV 0.69 (sensitivity 0.88; specificity 0.77)) and Ao I-ESRV35.5 (sensitivity 0.85; specificity 0.94) were used to analyze the high UA-RI vs UA-RI low MCA-RI and Ao I-ESRV high vsAo I-ESRV low vsAo I-ESRV of FGR pregnant women. The patients were divided into two groups: UA-RI high vs UA-RI low MCA-RI high and Ao I-ESRV high vsAo I-ESRV low, respectively. The patients with FGR were divided into two groups: UA-RI high vs UA-RI low MCA-RI high and Ao I-ESRV high vsAo I-ESRV low. Comparison of the degree of intrauterine hypoxia and the value of predicting pregnancy outcome in the middle and low groups there was no significant difference between the MCA-RI group and the Ao I-ESRV group in the degree of severe hypoxia. Conclusion: there is no significant difference in the UA-RI group. The Pi value of the middle cerebral artery S / D ESRV and ESRV of aortic arch isthmus were sensitive indexes to evaluate FGR. The analysis of umbilical artery, middle cerebral artery, aortic arch isthmus blood flow parameters in fetal growth and development limitation can further determine the degree of hypoxia, which has an important clinical application value.
【學(xué)位授予單位】：江蘇大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R714.5

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