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目的探讨超声血流监测重度子痫前期(PE)孕妇胎儿血流动力学变化的应用价值。方法选取2013年12月-2015年12月该院收治的50例重度PE患者为SPE组,50例轻度PE患者为MPE组,50例正常孕妇为对照组。对3组胎儿脐动脉、大脑中动脉的血流速度峰谷比(S/D)、搏动指数(PI)、阻力指数(RI)等血流动力学参数及胎儿生长受限(FGR)、胎儿窘迫、早产儿、低出生体重、围生儿死亡等围生儿不良预后发生率进行观察和比较。结果 SPE组胎儿的脐动脉血流动力学参数均显著高于MPE组,MPE组胎儿的脐动脉血流动力学参数均显著高于对照组,差异均有统计学意义(P<0.05);SPE组胎儿的大脑中动脉血流动力学参数均显著低于MPE组,MPE组胎儿的大脑中动脉血流动力学参数均显著低于对照组,差异均有统计学意义(P<0.05);SPE组围生儿PGR、胎儿窘迫、早产儿的发生率显著高于MPE组和对照组,围生儿死亡率高于对照组,差异均有统计学意义(P<0.05)。Logistic多元回归分析结果显示,围生儿不良预后与胎儿脐动脉S/D、PI、RI及大脑中动脉S/D、PI、RI均具有相关性(P<0.05)。结论重度PE胎儿表现为脐动脉阻力的上升和大脑中动脉阻力的下降,其变化幅度与PE病情和围生儿不良预后的发生风险相关,可作为评价PE患者病情及预测围生儿预后的辅助指标。
Objective To investigate the value of ultrasound blood flow monitoring of fetal hemodynamic changes in severe preeclampsia (PE). Methods From December 2013 to December 2015, 50 patients with severe PE in our hospital were selected as SPE group, 50 patients with mild PE as MPE group and 50 normal pregnant women as control group. The hemodynamic parameters such as blood flow velocity (S / D), pulsatility index (PI) and resistance index (RI) in the umbilical artery and middle cerebral artery of three groups were compared with those of FGR, Distress, premature children, low birth weight, perinatal mortality and other perinatal unhealthy prognosis were observed and compared. Results The umbilical arterial hemodynamic parameters in fetuses of SPE group were significantly higher than that of MPE group. The umbilical artery hemodynamics parameters of fetus in MPE group were significantly higher than those in control group (P <0.05). SPE The hemodynamic parameters of the middle cerebral artery of the fetus group were significantly lower than those of the MPE group. The hemodynamic parameters of the middle cerebral artery of the MPE group were significantly lower than those of the control group (P <0.05) The incidence of perinatal PGR, fetal distress and premature babies was significantly higher than that of MPE and control groups, and the perinatal mortality was higher than that of the control group (P <0.05). Logistic multivariate regression analysis showed that the poor prognosis of perinatal children correlated with S / D, PI, RI of fetal umbilical artery and S / D, PI, RI of middle cerebral artery (P <0.05). Conclusions Severe PE fetus showed the increase of resistance of umbilical artery and the decrease of middle cerebral artery resistance. The magnitude of change was related to the risk of PE and poor prognosis of PE. It could be used as a supplement to evaluate the condition of PE and predict the prognosis of perinatal index.