胎儿宫内窘迫采用彩色多普勒与三维超声联合诊断的临床价值

郑燕燕　吴敏华　陈巧敏

[摘要] 目的 探讨胎儿宫内窘迫采用彩色多普勒与三维超声联合诊断的临床价值。 方法 对38例经产后确诊为胎儿宫内窘迫的孕妇的产前检查结果进行回顾性分析，通过对其胎儿心率、脐动脉收缩期峰流速以及舒张末期流速之比（S/D）、阻力指数（RI）、大脑中动脉RI、搏动指数（PI）值等彩色多普勒检测指标进行分析，并结合三维超声重建图像，观察胎儿的胎动、脐带形态、绕颈周数以及空间转向等情况。依据脐带绕颈情况对孕妇进行分组，对比各组间的RI及S/D值。 结果 胎儿心率异常、胎动异常以及脐动脉、大脑中动脉血流参数异常是判定胎儿有无缺氧和缺氧程度的主要指标。而脐带缠绕、羊水过少是导致胎儿宫内窘迫的主要原因。彩色多普勒联合三维超声诊断结果与产后结果的符合率为98.0%。脐带绕颈周数不同的患儿，其RI及S/D值比较有统计学意义（P<0.05）。 结论 彩色多普勒与三维超声联合诊断能够准确及时地对胎儿宫内窘迫原因和程度进行诊断，为临床观察产程，分娩方式和时机的选择提供可靠的参考依据，对提高胎儿生存质量，预防和降低围产儿死亡率以及优生优育均具有极高的临床指导意义。

[关键词] 彩色多普勒；三维超声；胎儿宫内窘迫；宫内缺氧

[中图分类号] R445.1；R714.5 [文献标识码] B [文章编号] 2095-0616（2016）09-174-04

[Abstract] Objective To research the clinical value of color dopper combined with three-dimensional ultrasound in fetal distress. Methods 38 cases of prenatal examination were diagnosed as postpartum fetal distress in pregnant women were analyzed retrospectively.Through analyzed fetal heart rate，umbilical artery peak systolic velocity and diastolic velocity ratio （S/D），resistance index （RI），middle cerebral artery pulsatility index value （PI） of the children，and combined with 3D ultrasound image reconstruction，observed fetal movement，umbilical cord around neck shape，and spatial turn etc.According to the umbilical cord around the neck，grouped for pregnant women，and compared the value of RI and S/D. Results Fetal heart rate abnormalities，abnormal fetal movement and umbilical artery，middle cerebral artery blood flow parameters abnormality were determining prenatal hypoxic and anoxic degree of main indexes.And the umbilical cord and oligohydramnios was a major cause of fetal distress.The coincidence rate of color Doppler combined with three-dimensional ultrasound diagnosis and postnatal outcome was 98.0 %，there were significant differences between the RI and the S/D value in different umbilical cord around neck of children，and the differences were statistically significant （P<0.05）. Conclusion Color doppler combined with three-dimensional ultrasound can diagnose accurately and timely for the cause and extent of fetal distress，to provide a reliable reference for clinical observation of birth process，the timing and mode of delivery.To improve the quality of life of the fetus to prevent，reduce the perinatal mortality and eugenics has a high clinical significance.

[Key words] Color doppler；Three dimensional ultrasound；Fetal distress；Fetal hypoxia

胎儿宫内窘迫，是指胎儿在宫内出现缺氧征象，对其生命造成一定威胁的危及症状，是当前剖宫产的主要适应证之一。相关资料结果显示，其发病率约为2.7%～38.5%[1-2]。胎儿宫内窘迫多发生在妊娠后期以及临产过程中，是造成胎儿围产期死亡的主要原因，而脐带绕颈是胎儿出现宫内窘迫的最常见原因之一。通过彩色多普勒超声结合三维超声检查，能够发现出现宫内窘迫的原因和程度，以判断胎儿的缺氧程度和生理状况，以便及时采取有效措施进行干预[3]，从而降低新生儿的后遗症或死亡的发生。……