CAJ | 학술논문

目的：探讨中孕期静脉导管多普勒血流参数在预测胎儿生长受限中的应用价值。方法搜集我院产前检查的正常中孕期胎儿422例作为对照组；临床诊断为宫内生长受限的中孕期胎儿200例为研究组，分别测量两组胎儿静脉导管多普勒血流参数。以对照组静脉导管血流参数范围为正常参考值，结合脐动脉血流频谱表现，将研究组胎儿进行分组分析，并随访至妊娠结束，记录妊娠结局。结果对照组422例正常中孕期胎儿静脉导管血流参数：S 波流速：（59．02±16．32）cm／s ；A 谷流速：（32．87±11．27）cm／s ；RI ：0．45 ± 0．09；PI ：0．53 ± 0．13；S／D ：1．87 ± 0．34。研究组200例 FGR分为5组：①研究一组14例，胎儿静脉导管血流参数 S 波流速较对照组减低，两组间差异无统计学意义（ P ＞ 0．05），A 谷流速较对照组减低，RI 、PI 和 S／D 值较对照组增高（ P ＜ 0．05，两组间差异有统计学意义）；②研究二组16例，胎儿静脉导管血流参数 S 波流速和 A 谷流速较对照组减低，而 RI 、PI 和 S／D 值较对照组增高（ P ＜ 0．05），两组间差异有统计学意义）。脐动脉血流舒张期缺如或脐动脉 RI／大脑中动脉 RI ＞ 1．0；③研究三组9例，静脉导管 A 谷血流消失或出现反流，且脐动脉血流舒张期缺如或反流，其中7例经临床诊断为不良妊娠而引产，另 2例为双胎输血综合征中的供血儿，供血儿死亡后受血儿均妊娠至足月后分娩正常体重儿；④研究四组29例，胎儿表现为脐动脉血流频谱异常，而静脉导管血流频谱正常；⑤研究五组132例，胎儿静脉导管和脐动脉血流频谱均表现正常。结论中孕期 FGR 胎儿静脉导管多普勒血流频谱可反映胎儿宫内血氧及右心功能情况；当胎儿静脉导管多普勒血流频谱出现 A 谷血流消失或反流，且伴有脐动脉血流舒张期缺如或反流时，预示胎儿妊娠结局不良可能；静脉导管多普勒血流参数可作为预测 FGR 胎儿完好生存率的重要指标之一。目的：探討中孕期靜脈導管多普勒血流參數在預測胎兒生長受限中的應用價值。方法搜集我院產前檢查的正常中孕期胎兒422例作為對照組；臨床診斷為宮內生長受限的中孕期胎兒200例為研究組，分彆測量兩組胎兒靜脈導管多普勒血流參數。以對照組靜脈導管血流參數範圍為正常參攷值，結閤臍動脈血流頻譜錶現，將研究組胎兒進行分組分析，併隨訪至妊娠結束，記錄妊娠結跼。結果對照組422例正常中孕期胎兒靜脈導管血流參數：S 波流速：（59．02±16．32）cm／s ；A 穀流速：（32．87±11．27）cm／s ；RI ：0．45 ± 0．09；PI ：0．53 ± 0．13；S／D ：1．87 ± 0．34。研究組200例 FGR分為5組：①研究一組14例，胎兒靜脈導管血流參數 S 波流速較對照組減低，兩組間差異無統計學意義（ P ＞ 0．05），A 穀流速較對照組減低，RI 、PI 和 S／D 值較對照組增高（ P ＜ 0．05，兩組間差異有統計學意義）；②研究二組16例，胎兒靜脈導管血流參數 S 波流速和 A 穀流速較對照組減低，而 RI 、PI 和 S／D 值較對照組增高（ P ＜ 0．05），兩組間差異有統計學意義）。臍動脈血流舒張期缺如或臍動脈 RI／大腦中動脈 RI ＞ 1．0；③研究三組9例，靜脈導管 A 穀血流消失或齣現反流，且臍動脈血流舒張期缺如或反流，其中7例經臨床診斷為不良妊娠而引產，另 2例為雙胎輸血綜閤徵中的供血兒，供血兒死亡後受血兒均妊娠至足月後分娩正常體重兒；④研究四組29例，胎兒錶現為臍動脈血流頻譜異常，而靜脈導管血流頻譜正常；⑤研究五組132例，胎兒靜脈導管和臍動脈血流頻譜均錶現正常。結論中孕期 FGR 胎兒靜脈導管多普勒血流頻譜可反映胎兒宮內血氧及右心功能情況；噹胎兒靜脈導管多普勒血流頻譜齣現 A 穀血流消失或反流，且伴有臍動脈血流舒張期缺如或反流時，預示胎兒妊娠結跼不良可能；靜脈導管多普勒血流參數可作為預測 FGR 胎兒完好生存率的重要指標之一。
목적：탐토중잉기정맥도관다보륵혈류삼수재예측태인생장수한중적응용개치。방법수집아원산전검사적정상중잉기태인422례작위대조조；림상진단위궁내생장수한적중잉기태인200례위연구조，분별측량량조태인정맥도관다보륵혈류삼수。이대조조정맥도관혈류삼수범위위정상삼고치，결합제동맥혈류빈보표현，장연구조태인진행분조분석，병수방지임신결속，기록임신결국。결과대조조422례정상중잉기태인정맥도관혈류삼수：S 파류속：（59．02±16．32）cm／s ；A 곡류속：（32．87±11．27）cm／s ；RI ：0．45 ± 0．09；PI ：0．53 ± 0．13；S／D ：1．87 ± 0．34。연구조200례 FGR분위5조：①연구일조14례，태인정맥도관혈류삼수 S 파류속교대조조감저，량조간차이무통계학의의（ P ＞ 0．05），A 곡류속교대조조감저，RI 、PI 화 S／D 치교대조조증고（ P ＜ 0．05，량조간차이유통계학의의）；②연구이조16례，태인정맥도관혈류삼수 S 파류속화 A 곡류속교대조조감저，이 RI 、PI 화 S／D 치교대조조증고（ P ＜ 0．05），량조간차이유통계학의의）。제동맥혈류서장기결여혹제동맥 RI／대뇌중동맥 RI ＞ 1．0；③연구삼조9례，정맥도관 A 곡혈류소실혹출현반류，차제동맥혈류서장기결여혹반류，기중7례경림상진단위불량임신이인산，령 2례위쌍태수혈종합정중적공혈인，공혈인사망후수혈인균임신지족월후분면정상체중인；④연구사조29례，태인표현위제동맥혈류빈보이상，이정맥도관혈류빈보정상；⑤연구오조132례 ，태인정맥도관화제동맥혈류빈보균표현정상。결론중잉기 FGR 태인정맥도관다보륵혈류빈보가반영태인궁내혈양급우심공능정황；당태인정맥도관다보륵혈류빈보출현 A 곡혈류소실혹반류，차반유제동맥혈류서장기결여혹반류시，예시태인임신결국불량가능；정맥도관다보륵혈류삼수가작위예측 FGR 태인완호생존솔적중요지표지일。
Objective To investigate the clinical application of Doppler flow parameters of the ductus venosus in fetus during the second trimester in evaluating the prognosis of fetal growth restriction .Methods There were a control group (422 normal fetuses) and a study group(200 fetuses with FGR ) .We measured and analyzed Doppler flow parameters of the ductus venosus in fetuses of the two groups ,and the ultrasound findings were observed and recorded .We measured Doppler flow parameter RI of the umbilical artery and the middle cerebral artery in fetuses of the study group .200 fetuses were grouped into five groups according to Doppler flow parameters of the ductus venosus and the umbilical artery refer to the control group .Doppler flow parameters of the ductus venosus and the the umbilical artery and the ultrasound findings were analysed in each group .All these fetuses were followed up until the end of pregnancy and the pregnancy outcomes were recorded .Results Doppler flow parameters of the ductus venosus in 422 normal fetuses in control group were meas‐ured :Peak S :(59 .02 ± 16 .32) cm/s ,wave A :(32 .87 ± 11 .27) cm/s ,RI :0 .45 ± 0 .09 ,PI :0 .53 ± 0 .13 ,and S/D :1 .87 ± 0 .34 .200 fetuses in study group were divided into five groups based on Doppler flow parameters of the ductus venosus and the umbilical artery ① 14 cases appeared as Peak S was lower than that in control group( P > 0 .05) ,and wave D was low‐er but RI ,PI and S/D were higher than that in control group ( P < 0 .05) ; ② 16 fetuses appeared as Peak S and wave D were lower but RI ,PI and S/D were higher than that in control group ( P < 0 .05) .The umbilical artery was absent end‐diastolic flow or RI of the umbilical artery and RI of the middle cerebral artery ratio greater than 1 .0 ; ③ 9 cases appeared with absent or reversed wave A and the umbilical artery was absent or reversed end‐diastolic flow .Among them ,7 fetuses there induced labor ,and others were donor‐twins of TTTS ,whose donor‐twins were dead and the recipient‐twins were de‐livered at term with normal weight ; ④ Among 29 cases whose blood flow spectrum of the ductus venosus was normal but which of umbilical artery was abnormal ; ⑤ Among 132 cases whose blood flow spectrum of the ductus venosus and the umbilical artery were both normal .Conclusion The intrauterine oxygen condition and right heart function can be reflected by measuring and analyzing Doppler flow parameters of the ductus venosus in fetuses of FGR during the second trimester . When the fetus appears with absent or reversed wave A and the umbilical artery is absent or reversed end‐diastolic flow , pregnancy outcome will be adverse probably .So Doppler flow parameter of the ductus venosus in fetus during the second trimester is one of the important indicator in evaluating the intact survival rate of fetal growth restriction .