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目的评价脐动脉血流各指数变化值预测足月头位妊娠脐带绕颈致胎儿窘迫的价值及其两者之间关系。方法选择2004年1月至2006年2月我院采用彩色多普勒超声检测的66例孕足月头位脐带绕颈孕妇,检测其脐动脉血流收缩期振幅与舒张期比值(S/D)、阻力指数(R I)、搏动指数(PI)及胎心率值(FHR)在宫底推压试验前后的变化。追踪受检测者在临产前或产程中有无发生胎儿窘迫。结果脐带绕颈致胎儿窘迫S/D、R I、PI在宫底推压试验后升高值明显高于未发生胎儿窘迫组,胎心率变化发生率明显高于未发生胎儿窘迫组,两组间差异有统计学意义(P<0.01)。以宫底推压试验后S/D升高值>0.5,R I升高值>0.1,PI升高值>0.2或S/D≥2.6,R I≥0.6,PI≥0.9为预测警戒值,其符合率为74.2%~77.3%,特异性为63.0%~70.4%,敏感性为77.0%~87.0%,阳性预测率为76.2%~78.9%,阴性预测率为67.9%~77.3%。结论检测脐带绕颈处胎儿脐动脉血流S/D、R I、PI及FHR值在宫底推压试验前后的变化,可作为预测足月头位妊娠脐带绕颈致胎儿窘迫的一项较可靠指标,有较高临床价值。
Objective To evaluate the value of umbilical artery blood flow index changes in predicting full-term first-term gestational umbilical cord fetal distress around the neck and their relationship. Methods From January 2004 to February 2006, 66 cases of umbilical cord around the neck pregnant women were examined by color Doppler ultrasound in our hospital. The amplitude of the umbilical artery systolic and diastolic ratio (S / D ), Resistance index (RI), pulsatility index (PI) and fetal heart rate (FHR) before and after the end of the palace push test. Tracing whether the subject has fetal distress before or during labor. Results The values of fetal distress S / D, RI and PI in the fetal distress around the umbilical cord were significantly higher than those in the fetal distress group, and the incidence of fetal heart rate was significantly higher than that of the fetal distress group The difference was statistically significant (P <0.01). After the end of the palace push test S / D rise> 0.5, RI increased> 0.1, PI increased> 0.2 or S / D> 2.6, RI> 0.6, PI> 0.9 for the predicted alert value, which is consistent with The sensitivity was 77.0% -87.0%, the positive rate was 76.2% -78.9%, and the negative rate was 67.9% -77.3%. Conclusions The changes of S / D, RI, PI and FHR in umbilical artery blood flow around the neck of the umbilical cord can be used as a reliable index to predict fetal distress around the neck caused by uterine cord in the first months of pregnancy Indicators, a higher clinical value.