严玉玲 王琳 曹晓焱

【关键词】 大脑中动脉 肾动脉 心脏血流指标 胎儿宫内窘迫

[Abstract] Objective： To investigate the relationship between middle cerebral artery （MCA）， renal artery （RA） and cardiac blood flow indexes and the severity of fetal distress. Method： From January 2017 to February 2020， 100 pregnant women with regular prenatal examination in our hospital and definite diagnosis of fetal distress after delivery were selected as the experimental group， and another 100 pregnant women with regular prenatal examination and normal delivery in our hospital during the same period were selected as the control group. The resistance index （RI）， pulse index （PI） and the ratio of peak systolic velocity to end diastolic velocity （S/D） of MCA and RA were compared between two groups; The cardiac blood flow parameters of two groups were compared， including velocity time integration （VTI）， fetal heart rate （FHR） and cardiac output （CO）. At the same time， the above parameters of fetus with different degree of fetal distress were compared in the experimental group . Result： RI， PI and S/D of MCA in the experimental group were lower than those in the control group， while RI， PI and S/D of RA in the experimental group were higher than those in the control group （P<0.05）. RI， PI and S/D of MCA and RA in mild fetal distress of the experimental group were lower than those of moderate and severe fetal distress， RI， PI and S/D of of MCA and RA in moderate fetal distress were lower than those of severe fetal distress， the differences were statistically significant （P<0.05）. The VTI×FHR and CO of MCA and RA inthe experimental group were significantly lower than those in the control group （P<0.05）. The VTI×FHR and CO of MCA and RA in mild fetal distress of the experimental group were higher than those of moderate and severe fetal distress， VTI×FHR and CO of MCA and RA in moderate fetal distress were higher than those of severe fetal distress， the differences were statistically significant （P<0.05）. Conclusion： The blood flow parameters of middle cerebral artery， renal artery and heart in the fetus with intrauterine distress are significantly different from those in the normal fetus， and the differences are obvious in different severity， which can be used as an important reference index for the diagnosis and treatment of intrauterine distress.

[Key words] Middle cerebral artery Renal artery Cardiac blood flow index Fetal distress

First-author’s address： Futian District Maternal and Child Health Hospital， Shenzhen 518048， China

doi：10.3969/j.issn.1674-4985.2021.21.010

胎儿宫内窘迫是指胎儿因各种疾病导致缺氧危及胎儿健康和生命的综合征，严重者可遗留神经系统后遗症或者发生胎儿、新生儿死亡，是当前剖宫产的主要适应证之一[1-2]。胎儿宫内窘迫主要发生在临产过程，也可发生在妊娠后期。造成胎儿宫内窘迫主要包括母体血液含氧量不足、母胎间血氧运输交换障碍以及胎儿自身疾病的因素[3]。近年来，随着国家政策的放开，人工辅助生育技术越来越普及，以及环境污染、药物滥用等问题日益严重，使得胎儿宫内窘迫的发生率呈逐年上升趋势[4]。沈立新[5]研究表明，胎儿发生宫内缺氧时，使其动脉血流再分配，孕妇和胎儿可发生一系列适应性改变，最终使胎儿血流动力学模式的改变。此次研究选取2017年1月-2020年2月于本院就诊且经产后明确诊断为胎儿宫内窘迫的75例患儿，分析胎儿大脑中动脉（middle cerebral artery，MCA）、肾动脉（renal artery，RA）及心脏血流指标与胎儿宫内窘迫严重程度的关系，旨在通过血流参数的变化快速准确地评估宫内缺氧情况，从而早期诊断，合理治疗，降低胎儿宫内窘迫并发症发生率，预防胎儿宫内窘迫的发生、发展，为临床研究提供可靠依据，现报道如下。

1 资料与方法

1.1 一般资料 选择2017年1月-2020年2月于本院规律产检且经产后明确诊断为胎儿宫内窘迫的孕妇100例作为试验组，另选取同时期于本院规律产检并正常分娩健康正常胎儿的孕妇100例为对照组。……