本文選題：大腦中動脈　切入點：臍動脈　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的：探討超聲檢測孕晚期臍帶繞頸深度與大腦中動脈及臍動脈血流指標(biāo)的相關(guān)性,用于預(yù)測圍生期胎兒宮內(nèi)缺氧和宮內(nèi)窘迫的風(fēng)險,為臨床產(chǎn)科醫(yī)師對伴臍繞頸的臨產(chǎn)孕婦選擇合理的生產(chǎn)方式提供有效的決策依據(jù)。 研究方法：選取孕37-41周臍帶繞頸胎兒139例,其中繞頸一周者124例,繞頸兩周及以上者15例。均為單胎,孕婦年齡20-32歲,并取28例不伴臍帶繞頸的相同孕周范圍胎兒作為對照組,均已通過胎兒常規(guī)檢查排除先天性胎兒畸形并經(jīng)分娩后證實。用彩色多普勒超聲分別檢測對照組及臍帶繞頸組胎兒大腦中動脈(middle cerebral artery, MCA)及臍動脈(umbilical artery, UA)的收縮期最大流速與舒張期末流速的比值(S/D)、阻力指數(shù)(RI)及搏動指數(shù)(PI),同時分析臍帶繞頸組胎兒頸部皮膚壓跡深度與UA血流指數(shù)的相關(guān)性。并追蹤觀察其胎心監(jiān)測結(jié)果、生產(chǎn)方式、產(chǎn)程異常幾率、第二產(chǎn)程時間,并對結(jié)果進(jìn)行相關(guān)統(tǒng)計學(xué)分析。 結(jié)果：1.繞頸兩周及以上者共15例,皮膚壓跡最小深度為0.72cm,最大深度為1.18cm,平均深度0.872±0.135cm。繞頸一周者124例,皮膚壓跡最小深度為0.35cm,最大深度為1.38cm。依據(jù)皮膚壓跡深度進(jìn)行分組,皮膚壓跡深度小于0.60cm者19例,平均深度：0.501±0.155cm；壓跡深度0.60-0.69cm者39例,平均深度：0.669±0.072cm；壓跡深度：0.70-0.79cm者36例,平均深度：0.735±0.063cm；壓跡深度0.80-0.89cm者18例,平均深度：0.841±0.057cm；壓跡深度0.90cm以上者12例,平均深度：0.954±0.083cm。分別與對照組比較,發(fā)現(xiàn)UA的各項血流指標(biāo)均未見明顯差異；同時各觀察組間相互比較,UA的各項血流指標(biāo)亦未見明顯差異。 2.隨繞頸深度的增加,MCA的S/D、 RI、 PI逐漸增加。繞頸兩周及以上組MCA的S/D、RI、 PI均較對照組升高,其差異有統(tǒng)計學(xué)意義(p＜0.05)；壓跡深度0.80～0.89cm組及0.90cm以上組MCA的S/D、 RI、 PI均較對照組及其他觀察組升高,統(tǒng)計學(xué)有顯著性差異(p＜0.01)；壓跡深度小于0.60cm組、壓跡深度0.60～0.69cm組及壓跡深度0.70～0.79cm組與對照組比較及各觀察組間比較MCA的各項血流指標(biāo)均未見明顯差異。 3.圍產(chǎn)兒結(jié)局分析：繞頸組與對照組比較：繞頸兩周及以上組全部剖宮產(chǎn)。繞頸一周組剖宮產(chǎn)幾率明顯升高,陰道產(chǎn)第二產(chǎn)程時間延長,以繞頸深度大于0.80cm者顯著,其差異均有統(tǒng)計學(xué)意義(p＜0.05)；繞頸深度小于0.80cm組與對照組間比較：其胎心監(jiān)護(hù)異常幾率及產(chǎn)程異常幾率較對照組雖有升高,但其差異無統(tǒng)計學(xué)意義；壓跡深度大于0.80cm組與對照組間比較：胎心監(jiān)護(hù)異常幾率明顯增高,其差異有統(tǒng)計學(xué)意義(p＜0.05)。 結(jié)論：本組研究表明在預(yù)測胎兒是否出現(xiàn)宮內(nèi)窘迫方面,大腦中動脈的各項血流指標(biāo)較臍動脈的血流指標(biāo)更為敏感。同時繞頸一周且較松(頸后皮膚壓跡深度小于0.80cm)的情況下胎兒各項血流指標(biāo)未見明顯異常,孕婦及醫(yī)務(wù)人員不必過分緊張焦慮；但繞頸較緊(頸后皮膚壓跡深度0.80cm以上)者及兩周以上者大腦中動脈的S/D. PI、RI均較對照組顯著升高,其差異具有統(tǒng)計學(xué)意義,可能會導(dǎo)致胎兒宮內(nèi)缺氧,必須引起臨床醫(yī)師足夠的重視。同時臍帶繞頸會影響胎兒先露下降,導(dǎo)致第二產(chǎn)程時間延長,并且胎心監(jiān)護(hù)異常幾率增高,尤其以繞頸較緊、周數(shù)較多者顯著。因此對于臍帶繞頸者,臨床產(chǎn)科醫(yī)師必需加強(qiáng)產(chǎn)前監(jiān)護(hù)并適時合理選擇分娩方式,特別是對臍帶繞頸較緊(壓跡深度0.80cm以上者)、周數(shù)較多者更要慎重,以減少圍產(chǎn)兒不良結(jié)局的發(fā)生。利用測量臍帶繞頸頸后皮膚壓跡深度這一檢測方法判斷臍帶纏繞的松緊程度簡單易行,有利于臨床推廣。這一檢測方法對于間接判斷臍帶纏繞的松緊程度切實有效,更適合臨床需要,可以為臍帶繞頸孕婦分娩方式的選擇提供有價值的決策依據(jù)。
[Abstract]:Objective: To investigate the correlation between ultrasonic detection of late pregnancy umbilical cord around the neck and the depth of the middle cerebral artery and umbilical artery blood flow index, for the prediction of perinatal fetal hypoxia and fetal distress risk, provide an effective basis for clinical obstetrician for pregnant women with umbilical cord around the neck of the rational choice of production mode.
Methods: select 37-41 weeks of gestation fetuses with umbilical cord around the neck in 139 cases, including 124 cases around the neck a week, around the neck for two weeks or more. 15 cases were singleton pregnant women, age 20-32 years, and 28 cases with cord around the neck of the same gestational age range of the fetus as the control group, have through routine examination to exclude fetal congenital fetus malformation and confirmed after delivery. The control group were detected and the umbilical cord around the neck group in the fetal brain artery with color Doppler ultrasound (middle cerebral, artery, MCA) and umbilical artery (umbilical artery UA) the ratio of the systolic peak velocity and diastolic velocity (S/D), resistance index (RI) and pulsatility index (PI), correlation analysis of umbilical cord around the fetal neck neck skin group impressio depth and UA blood flow index. At the same time and followed up the fetal heart monitoring results, the mode of production, the probability of abnormal labor, the second stage of labor time, and related statistics on the results Study analysis.
Results: 1. around the neck for two weeks and more than 15 cases of skin impressio minimum depth is 0.72cm, the maximum depth is 1.18cm, 124 cases a week average depth of 0.872 + 0.135cm. around the neck, skin impressio minimum depth is 0.35cm, the maximum depth is 1.38cm. on the basis of skin impression depth were divided into two groups, 19 cases of skin. The impression of depth less than 0.60cm in average depth: 0.501 + 0.155cm; 39 cases, impressio depth 0.60-0.69cm average depth: 0.669 + 0.072cm; impressio depth: 36 cases, 0.70-0.79cm average depth: 0.735 + 0.063cm; 18 cases, impressio depth 0.80-0.89cm average depth: 0.841 + 0.057cm; 12 cases, impressio the depth of more than 0.90cm in average depth: 0.954 + 0.083cm. respectively compared with the control group, the blood flow index of UA had no significant difference; at the same time, the observation group compared with each other, the blood flow index of UA also showed no significant difference.
2. with the increase of depth around the neck, MCA, S/D, RI, PI gradually increased. Around the neck for two weeks and above group MCA S/D, RI, PI were higher than those in control group, the difference was statistically significant (P < 0.05); impressio depth of 0.80 ~ 0.89cm group and 0.90cm group than MCA S/D. RI and PI were compared with control group, the observation group increased, there was statistically significant difference (P < 0.01); the impression of depth is less than the 0.60cm group, the impression of depth of 0.60 ~ 0.69cm group and 0.70 to the blood pressure trace depth index of 0.79cm group compared with the control group and the observation group MCA showed no obvious the difference.
3. perinatal outcome analysis: around the neck group compared with the control group: around the neck for two weeks and above all cesarean section around the neck a week. Probability of cesarean section increased vaginal delivery during the second stage of labor time, at around the neck depth more than 0.80cm significantly, the differences were statistically significant (P < 0.05); around the neck depth is less than the 0.80cm group and the control group comparison: the abnormal fetal heart rate and abnormal labor rate was higher than the control group, but the difference was not statistically significant; the impression of depth is greater than the 0.80cm group and the control group comparison: abnormal fetal heart rate increased obviously, there was a statistically significant the difference (P < 0.05).
Conclusion: This study showed that in the prediction of fetal intrauterine distress or blood flow, blood flow index in the index of middle cerebral artery in the umbilical artery is more sensitive. At the same time around the neck a week and loose (neck skin impression depth is less than 0.80cm) under the condition of the fetus blood flow index had no obvious abnormalities, pregnant women and the medical staff do not have too much anxiety; but more tightly around the neck (cervical skin after impression of depth is more than 0.80cm) and more than two weeks in the brain artery of S/D. PI and RI were significantly higher than the control group, the difference was significant, may cause fetal hypoxia, the clinician must pay enough attention to at the same time. Umbilical cord around the neck will affect fetal presentation decline, resulting in the second stage of labor time, and increase the probability of abnormal fetal heart rate monitoring, especially around the neck is tight, the number of weeks was more significant. So the umbilical cord around the neck, clinical production Physicians must strengthen prenatal care and timely delivery mode selection, especially on the umbilical cord around the neck is tight (impressio depth more than 0.80cm), the number of weeks is much more carefully, to reduce perinatal adverse outcomes. By measuring the umbilical cord around the neck neck skin after the impressio depth detection method to judge the tightness the degree of the umbilical cord is simple, is conducive to clinical practice. This method is effective to indirectly determine the tightness of cord entanglement, more suitable for clinical needs, can provide valuable basis for decision making of umbilical cord around the neck delivery options.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.5;R445.1

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