张晨凌　凌晓娟

[摘 要] 目的：观察孕晚期脐动脉血流动力学参数预测胎儿窘迫的准确度，为胎儿窘迫早期判断提供参考依据。方法：回顾性分析我院2013年5月—2015年5月收治的175例孕产妇资料。按照胎儿情况将胎儿窘迫者纳入窘迫组（n=74），将胎儿正常者纳入对照组（n=101），比较2组受试者妊娠32～41周未临产时脐动脉血流动力学参数差异，分析其对胎儿窘迫的预测价值。结果：窘迫组孕产妇脐动脉收缩期峰值/舒张期峰值（S/D）显著高于对照组，差异有统计学意义（P<0.05），2组孕产妇脐动脉阻力指数（RI）、搏动指数（PR）比较，差异无统计学意义（P>0.05）。以S/D>3.0为判断标准，脐动脉S/D预测胎儿窘迫的灵敏度为58.1%（43/74）、特异性为88.1%（89/101）。结论：孕晚期脐动脉S/D变化预测胎儿窘迫具有一定价值，脐动脉S/D≤3.0的产妇，基本可排除胎儿窘迫风险，对于脐动脉S/D>3.0的产妇，应高度怀疑存在胎儿窘迫。

[关键词] 孕晚期；脐动脉；血流动力学参数；胎儿窘迫；预测

中图分类号：R714.4 文献标识码：B 文章编号：2095-5200（2016）03-008-03

[Abstract] Objective： To observe the accuracy of umbilical arterial blood flowing indexes in late pregnancy for prediction of fetal distress， provide reference basis for early judgment of fetal distress. Methods： Retrospective analysis of 175 cases of maternal information from May 2013 to May 2015. According to the fetal development situation， the parturients with fetal distress were included in distress group （n=74）， the healthy parturients were included in control group （n=101）. Compared the difference of umbilical artery blood flowing indexes between two groups of 32-41 weeks parturients， and analyzed its predictive value for fetal distress. Results： Maternal umbilical artery peak-systolic/diastolic ratio of distress group （S/D） was significantly higher than that of control group， the difference was statistically significant （P<0.05）. Maternal umbilical arterial resistance index （RI）， pulse index （PR） of two groups were compared， there were no statistically significant difference （P>0.05）. S/D>3.0 was used as the judgment standard， the sensitivity of umbilical artery S/D for predicting fetal distress was 58.1% （43/74）， specificity of 88.1% （89/101）. Conclusions： umbilical arterial S/D change in late pregnancy has a certain value for prediction of fetal distress， umbilical artery S/D of the parturients≤3.0 can basically eliminate risk of fetal distress， and women with umbilical arterial S/D>3.0 should be highly suspected to be fetal distress.

[Key words] late pregnancy； umbilical artery； blood flowing indexes； fetal distress； prediction

胎儿窘迫多由胎儿在母体子宫内因急慢性缺氧引发的代谢性酸中毒导致，是围产儿死亡和儿童神经系统损害的主要原因，其发生率为2.7%～38.5%[1]。胎心监护是临床常用胎儿窘迫预测方法，但假阳性率偏高，有可能导致无谓的剖宫产；即时胎儿动脉血血气及酸碱度分析是早期诊断胎儿窘迫的金标准，但其创伤较大、操作复杂度高，难以推广[2]。有学者发现，彩色多普勒超声监测脐血流对胎儿生长受限、羊水过少、脐带异常较为敏感[3]，为探讨孕晚期脐动脉血流动力学参数可否在胎儿窘迫预测中发挥作用，本研究选取我院2013年5月—2015年5月收治的175例孕产妇进行了分析。