彩色多普勒超声在妊娠期高血压孕妇子宫动脉血流动力学参数监测中的意义及对母婴结局影响

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摘要目的探讨超声在妊娠期高血压孕妇子宫动脉血流动力学参数测量的临床意义及对母婴结局影响。方法选取2017年1月至2018年11月在北京大学国际医院就诊的200例妊娠期高血压孕妇,作为试验组,同期200例正常妊娠孕妇作为对照组,所有孕妇均经腹部彩色多普勒超声检查子宫动脉搏动指数(PI)、阻力指数(RI)、脐动脉收缩压最大血流速度(S) 与舒张末期最大血流速度(D) 比值(S/D),观察两组孕妇子宫动脉血流动力学参数和胎儿脐动脉血流动力学参数,以及母婴结局情况。结果对照组孕妇的子宫动脉血流动力学参数PI、RI、S/D值随着孕周的增长而逐渐下降,孕中期和孕晚期,试验组子宫动脉血流动力学参数PI、RI、S/D值均比对照组明显升高(P<0.05);随着孕周的增加,对照组及试验组脐动脉血流动力学参数PI、RI、S/D值均明显降低(P＜0.05);孕中期和孕晚期,试验组脐动脉血流动力学参数PI、RI、S/D值比对照组升高,但差异无统计学意义;试验组早产率(7.5%)、新生儿窒息发生率(7.5%)、产后出血量[(526.3±23.3)ml]明显高于对照组[依次为1.0%、0.5%、(298.3±23.6)ml],差异有统计学意义;试验组的新生儿体重[(2.9±0.9 )kg]明显低于对照组[(3.3±0.2)kg],差异有统计学意义;两组孕妇剖宫产率和胎儿宫内窘迫率比较,差异无统计学意义。结论超声检查可以显示妊娠期高血压孕妇子宫动脉血流动力学各参数及胎儿脐动脉血流动力学参数的变化情况,对预测母婴结局提供客观依据。

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关键词 ：超声, 妊娠期高血压孕妇, 子宫动脉血流动力学参数, 母婴结局

Abstract：Objective To investigate the clinical significance of ultrasonography in the measurement of uterine artery hemodynamic parameters in pregnant women with gestational hypertension and its effect on maternal and infant outcomes.Methods 200 pregnant women with gestational hypertension from January 2017 to November 2018 in Peking University International Hospital were selected as pregnancy-induced hypertension group (PIH) and 200 pregnant women with normal blood pressure as control group. All pregnant women were examined by abdominal color Doppler ultrasound for uterine artery pulsation index (PI), resistance index (RI) and umbilical artery systolic pressure. The ratio of blood flow velocity (S) to maximum end-diastolic flow velocity (D) was used to observe the uterine artery hemodynamic parameters, fetal umbilical artery hemodynamic parameters and maternal and infant outcomes.Results The PI, RI and S/D values of uterine artery hemodynamics in the control group decreased with gestational weeks. The values of PI, RI and S/D of uterine artery hemodynamics in the PIH group were significantly higher than those in the control group (P<0.05); the umbilical artery blood flow in the control group and the PIH group was significantly higher than that in the control group (P<0.05) in the second and third trimesters of pregnancy. The values of PI, RI and S/D of umbilical artery hemodynamics in the PIH group were significantly lower than those in the control group with the increase of gestational weeks (P<0.05). In the second and third trimesters of pregnancy, the values of PI, RI and S/D of umbilical artery hemodynamics in the PIH group were higher than those in the control group, but there was no significant difference. The premature birth rate, the incidence of neonatal asphyxia and postpartum hemorrhage was 7.5%, 7.5% and (526.3±23.3) ml in PIH group, which was significantly higher than that of the control group [1.0%, 0.5% and (298.3±23.6) ml]. Neonatal weight was (2.9±0.9) kg in the PIH group which was significantly lower than that of the control group [(3.3±0.2) kg], and the difference was statistically significant; the of the pregnant women in the two groups was significantly lower than that of the control group There was no significant difference between the rate of cesarean section birth and fetal distress.Conclusion Ultrasonography can show the changes of uterine artery hemodynamic parameters and fetal umbilical artery hemodynamic parameters in pregnant women with gestational hypertension, and provide objective basis for predicting maternal and infant outcomes.

Key words： ultrasound pregnant women with gestational hypertension uterine artery hemodynamic parameters maternal and infant outcomes

收稿日期: 2018-11-28

通讯作者: 马强(jzviq79@163.com)

引用本文:

马强, 蔺莉, 梁雪静, 孙凤群. 彩色多普勒超声在妊娠期高血压孕妇子宫动脉血流动力学参数监测中的意义及对母婴结局影响[J]. 中国生育健康杂志, 2019, 30(6): 524-529.
MA Qiang, LIN Li, LIANG Xuejing, SUN Fengqun. Significance of color Doppler ultrasonography in monitoring uterine artery hemodynamic parameters of pregnant women with gestational hypertension and its effect on maternal and infant outcomes. Chinese Journal of Reproductive Health, 2019, 30(6): 524-529.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2019/V30/I6/524

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