【摘要】 目的分析胎心监护结合胎儿脐动脉(UA)、大脑中动脉(MCA)各项阻力指标比值对胎儿宫内窘迫的诊断价值。方法选取2015年1月至2016年12月在绍兴市妇幼保健院就诊的206例胎儿宫内窘迫的孕晚期孕妇为观察组,318例正常妊娠者为对照组。采用胎儿监护仪检测两组胎心监护情况,并用彩超检查两组胎儿的UA、MCA各项阻力指标,并进行统计分析。结果观察组胎心监护异常率为69.42%,明显高于对照组的28.62%(χ~2=84.21,P<0.01)。观察组胎儿UA收缩期峰值流速与舒张末期血流速度的比值(S/D)、阻力指数及搏动指数均明显高于对照组(t值分别为6.80、10.70、20.35,均P<0.01);MCA中S/D值、阻力指数及搏动指数均明显低于对照组(t值分别为9.87、12.29、10.55,均P<0.01);MCA与UA各项阻力指标比值均明显低于对照组(t值分别为12.01、13.91、14.86,均P<0.01)。胎心监护结合胎儿MCA与UA各项阻力指标比值的受试者工作特征曲线下面积最大为0.91,且敏感度和约登指数最高,分别为95.15%、80.68。结论胎心监护结合彩超检查胎儿MCA和UA各项阻力指标比值对诊断胎儿宫内窘迫具有较高的评估价值,值得临床应用。更多还原

【Abstract】 Objective To analyze the diagnostic value of fetal heart monitoring combined with the ratio of umbilical artery(UA) and middle cerebral artery(MCA) for fetal distress. Methods From January 2015 to December 2016, 206 pregnant women with fetal distress in late pregnancy from Shaoxing Maternal and Child Health-Care Center were selected as observation group and 318 normal pregnant women as control group. Fetal monitor was used to detect fetal heart rate for the two groups, and color Doppler ultrasound was used to detect the resistance index of MCA and UA in two groups. Results The abnormal rate of fetal supervision in the observation group was 69.42%, which was significantly higher than that in the control group(28.62%)(χ~2=84.21,P<0.01). The peak-systolic/diastolic ratio(S/D), resistance index and pulsatility index of UA in the observation group were significantly higher than those in the control group(t value was 6.80, 10.70 and 20.35, respectively, all P<0.01). The S/D value, resistance index and pulsatility index of MCA were significantly lower than those in the control group(t value was 9.87, 12.29 and 10.55, respectively, all P<0.01). The ratios of MCA to UA resistance indexes were significantly lower than those in the control group(t value was 12.01, 13.91 and 14.86, respectively, all P<0.01). The maximum area under the receiver operating characteristic curve of fetal heart monitoring combined with the ratio of MCA to UA was 0.91. The sensitivity and Youden index were highest, and they were 95.15% and 80.68, respectively. Conclusion Fetal heart monitoring combined with color Doppler ultrasonography to detect the ratio of MCA and UA resistance indicators in the diagnosis of fetal distress has high estimated values, so it is worthy of clinical application.更多还原