【摘要】 目的探讨宫内生长受限胎儿异常动静脉多普勒频谱改变及与围生结局的相关性。方法选取67例宫内生长受限胎儿(FGR)检测脐动脉(UA)、大脑中动脉(MCA)等外周动脉循环及静脉导管(DV)的血流频谱。根据异常血流频谱的改变分为3组:1组,RIUA升高,不伴RIMCA改变;2组,RIUA升高伴RIMCA降低;3组,DV静脉峰值流速指数(PVIV)增高,或DV-A波下降、缺失/负向。结果 UA舒张末期血流缺失/负向及RIMCA/RIUA<1在3组中的分布分别为1组2例(6.9%)、3例(10.3%);2组2例(8.7%)、16例(69.6%);3组9例(60%)、13例(86.7%)。静脉导管A波缺失/负向4例,均在3组。3组的不良围生结局分别为6.9%、39.1%、100%。不良围生结局的DV-PVIV、RIUA显著高于围生结局良好者,是预测不良围生结局的良好指标。结论动静脉多普勒联合检查评价宫内生长受限胎儿是非常必要的。DV-PVIV、S/A、RIUA是预测不良围生结局的良好指标。当UA舒张末期血流缺失或RIMCA/RIUA<1时,及时监测静脉导管血流频谱,减少不良围生结局的发生。更多还原

【Abstract】 Objective:To assess the relationship between abnormal arterial and venous Doppler findings and perinatal outcome in fetal growth restricted pregnancies(FGR). Methods:Doppler velocimetry of the umbilical artery(UA),middle cerebral artery(MCA),ductus venosus(DV)was performed in 67 FGR fetuses. Groups based on the last Doppler exam were:1. abnormal UA-RI only, 2. MCA-RI below the gestational age mean in addition to abnormal UA-RI, 3. DV peak velocity index(PVIV)above the gestational age mean and absent/reversed"a"waves in ductus venosus(DV). Results:Absent/reversed umbilical enddiastolic flow(AREDF)and ratio of RIMCA to RIUA below 1 was observed in 2(6.9%)and 3(10.3%)fetuses in group 1, 2(8.7%)and 16(69.6%)fetuses in group 2 and 9(60%)and 13(86.7%)fetuses in group 3. Absent/reversed"a"waves in ductus venosus was observed in 4 fetuses in group 3. Adverse perinatal outcome was 6.9%,39.1%and 100%respectively in 3 groups. Doppler indices of DV-PVIV,S/A,and RIUA were high in adverse perinatal outcome than in normal perinatal outcome. Conclusion:Multi-vessel Doppler examinations are highly necessary in assessing the outcome of FGR. The significant predicting factors for adverse perinatal outcome were DV-PVIV,S/A,and RIUA. In fetuses with AEDF or ratio of RIMCA to RIUA below 1,DV Doppler allows detection of further deterioration.更多还原