子宫动脉胎儿脐动脉血流变化对胎儿生长受限临床意义

子宫动脉胎儿脐动脉血流变化对胎儿生长受限临床意义 子宫动脉胎儿脐动脉血流变化对胎儿生长 受限临床意义 [摘要] 目的,探讨子宫动脉胎儿脐动脉血流变化对胎儿生长受限的临床意义。方法,回顾性我院2007年1月,2010年5月收治入院的胎儿生长受限患者200例的临床资料。结果,观察组产妇子宫动脉脐动脉血流速度峰谷比,S/D,值为,2.70?1.26,,对照组为,1.76?0.35,,胎儿脐动脉S/D值分别为,2.39?0.38,和,2.85?0.61,,两组比较,差异均 有统计学意义,均P,0.01,。观察组经肝素治疗2个疗程后胎儿出生时平均每周双顶径、股骨长、头围、腹围增长及Apgar评分、体重情况与对照组比较,差异无统计学意义,P,0.05,。5例死亡病例产前胎儿脐血流检查S/D值升高,平均为,4.8?1.6,。说明彩色多普勒测量子宫动脉及胎儿脐动脉检查是评估胎儿疾病严重程度的最佳指标。结论,彩色多普勒测量子宫动脉及胎儿脐动脉检查可以作为胎儿生长受限的常规监测措施,了解治疗效果,确定分娩时机。肝素对于治疗胎儿生长受限效果显著,可作为临床首选药。 [关键词] 肝素,胎儿生长受限,子宫动脉,胎儿脐动脉 [中图分类号] R714.5[文献标识码],[文章编 1 号]1673-7210,2011,03,c,-046-03 Clinical significance on fetal umbilical artery blood flow changes of uterine artery for the fetal growth restriction XU Jinmao, CHEN Taoying, ZHENG Hongping, LIN Limei The Features Branch, Maternal and Child Health Hospital of Longgang District in Shenzhen City, Guangdong Province, Shenzhen 518172, China [Abstract] Objective: To observe the clinical significance on fetal umbilical artery blood flow changes of uterine artery for the fetal growth restriction. Methods: The clinical data of 200 patients of fetal growth restriction in our hospital from January 2007 to May 2010 were retrospectively analyzed. Results: In the observation group, the maternal uterine artery S/D was (2.70?1.26) and was (1.76?0.35) in the control group; fetal umbilical artery S/D was (2.39?0.38) and (2.85?0.61) respectively, the difference between the two groups was significant (P0.05). 5 fatal cases of prenatal umbilical check S/D ratio increased with an average of (4.8?1.6). That color Doppler measurement of uterine artery and fetal umbilical artery examination was to assess the fetus the best indicator of 2 disease severity. Conclusion: Color Doppler measurement of uterine artery and fetal umbilical artery checks can be used as routine monitoring of fetal growth restriction measures, understand the treatment, to determine delivery time. Heparin for the treatment of significant effect of fetal growth restriction can be used as the preferred clinical medicine. [Key words] Heparin; Fetal growth retardation; Uterine artery; Fetal umbilical artery 妊娠期合并胎儿生长受限,fetal growth restriction,导致 子宫胎盘缺血缺氧,甚至围生儿死亡,是产科严重的并发症 之一[1]。彩色多普勒超声是一种胎儿形态学与血流动力学相 结合的诊断方法[2]。本文旨在探讨妊娠期孕妇胎儿脐动脉血 流动力学的彩色多普勒超声及临床意义。笔者通过对 2007年1月,2010年5月收治入院的胎儿生长受限的患者 200例,并在患者治疗前后采用彩色多普勒测量子宫动脉及 胎儿脐动脉的血流变化,旨在早期防治胎儿生长受限,改善 妊娠结局。现报道如下, 1 资料与方法 1.1 一般资料 选取我院2007年1月,2010年5月收治入院的胎儿生 长受限的患者200例,妊周为,32?4,周,年龄25,30岁。 3 病因,贫血营养不良31例,宫内感染32例,妊娠高血压73例,原因不明者21例,脐带和胎盘因素20例,甲状腺功能低下5例,妊娠合并糖尿病15例,心功能异常9例,均无肝素使用禁忌证。随机选取我院同期健康体检孕妇200例为对照组,孕周,32?3,周,年龄22,31岁。两组患者年龄、孕次、产次等比较差异无统计学意义,P,0.05,,具有可比性。 1.2 治疗方法 所有患者取左侧卧位,吸氧30 min,2次/d。均衡饮食,包括水、蛋白质、氨基酸、维生素等,同时监测脐动脉血流速度峰谷比,S/D,值,每4或7天复查一次,直至S/D值正常。门诊随诊至足月分娩。观察组给予硝苯地平10 mg口服,3次/d,多种氨基酸1片,3次/d,低分子右旋糖苷500 ml加复方丹参注射液30 ml静滴。肝素50 mg加5%葡萄糖溶液500 ml静滴,1次/d,7 d为1个疗程,使用2个疗程。 1.3仪器与测定方法 使用GEV730型彩色多普勒超声诊断仪,探头频率3.5 4 MHz。在距胎盘入口1,2 cm处及双侧子宫动脉呈十字交叉通过髂处动脉约1 cm处监测二者血流,获取连续5个心动周期频谱后测定脐动脉及子宫动脉及血流频谱。通过内储软件求得各波比值的数学平均值即S/D值。当S/D值大于或等于该孕周正常范围的90th百分位者为异常。 1.4 围生儿预后判断[3] 围生儿预后不良程度根据,?新生儿Apgar评分 5