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目的探讨妊娠期合并急性肾损伤(AKI)孕妇子宫动脉及脐动脉血流动力学指标预测不良妊娠结局的价值。方法选取2012年1月-2013年12月间该院收治的妊娠10~40周的单胎妊娠孕产妇1 518例,共诊出AKI孕妇42例(AKI组)、正常妊娠1 476例(正常妊娠组),分别于妊娠早期、中期、晚期检测孕妇子宫动脉、脐静脉的血流动力学指标,记录妊娠结局。结果随着孕周进展,正常妊娠组孕妇子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期与舒张期血流比值(S/D)均逐渐降低,各孕周之间差异均有统计学意义(t值分别为8.924、8.041、6.371,均P<0.05);AKI组PI、RI、S/D值逐渐增加到妊娠中期达到峰值,与同期正常妊娠组相比差异均有统计学意义(t值分别为7.740、6.391、7.209,均P<0.05)。AKI组胎儿妊娠早期、妊娠中期、妊娠晚期脐动脉的PI、RI、S/D值均明显高于正常妊娠组胎儿,差异有统计学意义(t值分别为5.921、5.063、4.997,均P<0.05;t值分别为7.052、7.114、6.821,均P<0.05;t值分别为8.063、8.810、9.072,均P<0.05)。AKI组分娩孕周、新生儿出生体重、胎盘重量均明显小于正常妊娠组,差异有统计学意义(t值分别为6.924、6.033、6.521,均P<0.05);胎儿心率异常率、剖宫产率、新生儿窒息率、围产儿死亡率均明显高于正常妊娠组,差异有统计学意义(χ2值分别为8.021、7.446、7.031、8.591,均P<0.05)。结论子宫动脉和脐动脉血流动力学指标可有效预测AKI孕妇不良妊娠结局,具有无创检查优势。
Objective To investigate the value of uterine artery and umbilical artery hemodynamics in pregnant women with acute renal injury (AKI) to predict adverse pregnancy outcomes. Methods A total of 1 518 cases of singleton pregnancies between 10 and 40 weeks of gestation in our hospital from January 2012 to December 2013 were selected. A total of 42 AKI cases (AKI group) and 1 476 normal pregnancies (normal Pregnancy group), respectively, in early pregnancy, mid-term and late detection of uterine artery in pregnant women, umbilical vein hemodynamic indicators of pregnancy outcome. Results With the progress of gestational age, the uterine artery pulsatility index (PI), resistance index (RI), systolic and diastolic blood flow ratio (S / D) of pregnant women decreased gradually, and the differences among gestational weeks Statistical significance (t = 8.924,8.041,6.371, respectively, P <0.05); AKI PI, RI, S / D values gradually increased to peak in the second trimester of pregnancy, compared with the same period of normal pregnancy group were statistically significant differences Significance (t values were 7.740,6.391,7.209, all P <0.05). The PI, RI and S / D values of umbilical artery in early pregnancy, mid-pregnancy and late-pregnancy in fetus in AKI group were significantly higher than those in normal pregnancy group (t = 5.921, 5.063 and 4.997, respectively, P < 0.05; t values were 7.052,7.114,6.821, respectively, P <0.05; t values were 8.063,8.810,9.072, P <0.05). AKI group gestational age, newborn birth weight and placental weight were significantly less than normal pregnancy group, the difference was statistically significant (t values were 6.924,6.033,6.521, all P <0.05); fetal heart rate abnormalities, cesarean section Rates, neonatal asphyxia and perinatal mortality were significantly higher than those in normal pregnancy (χ2 = 8.021, 7.446, 7.031, 8.591, respectively, P <0.05). Conclusion The uterine artery and umbilical artery hemodynamic parameters can effectively predict adverse pregnancy outcomes of AKI pregnant women with the advantage of noninvasive examination.