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目的 探讨足月头位妊娠脐带绕颈孕妇脐动脉血流速度波形和胎心率在加压试验前后的变化及与胎儿窘迫之间的关系。方法 2 0 0 1年 1月至 2 0 0 3年 6月间广东省茂名市人民医院采用彩色多普勒超声检测 33例孕足月头位妊娠脐带绕颈孕妇的脐动脉S/D、RI、PI及胎心率 (FHR)值在加压试验前后的变化。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组脐动脉S/D、RI、PI在加压试验后升高值明显高于未发生胎儿窘迫组 ,胎心异常变化发生率明显高于未发生胎儿窘迫组 ,两组间差异有显著性意义 (P <0 0 1)。以加压试验后S/D升高值 >0 5、RI升高值 >0 1、PI升高值 >0 2或S/D≥ 2 6、RI≥ 0 6、PI≥ 0 9为预测警戒值 ,其符合率 72 7%～ 75 8%、特异性 6 1 5 %～ 6 9 2 %、敏感性 75 0 %～ 85 0 %、阳性预测值 76 2 %～78 9%、阴性预测值 6 4 3%～ 72 7%。结论 检测脐带绕颈处胎儿脐动脉血流S/D、RI、PI及FHR值在加压试验前后的变化 ,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 ,有较高的临床价值。
Objective To investigate the changes of umbilical artery blood flow velocity and fetal heart rate before and after pressure test in fetal umbilical cord around the neck of full-term pregnancy and its relationship with fetal distress. Methods From January 2001 to June 2003, Maoming People’s Hospital of Guangdong Province used color Doppler ultrasonography to examine the S / D and RI , PI and fetal heart rate (FHR) values before and after the pressure test changes. Tracing whether the subject has fetal distress before or during labor. Results Umbilical cord around the neck caused by fetal distress group umbilical artery S / D, RI, PI increased significantly higher than the pressure test did not occur after fetal distress group, the incidence of abnormal fetal heart rate was significantly higher than the group did not occur fetal distress, two There was significant difference between groups (P <0.01). To pressure test after the S / D increases> 0 5, RI increased> 0 1, PI increased> 0 2 or S / D ≥ 2 6, RI ≥ 0 6, PI ≥ 0 9 for the predictive alert , The coincidence rate was 72.7% -75.8%, the specificity was 61.5% -629.2%, the sensitivity was 75% -85%, the positive predictive value was 76.2% -78.9%, the negative predictive value was 6 4 3% ~ 72 7%. Conclusion The changes of S / D, RI, PI and FHR of umbilical artery blood flow around the neck of the umbilical cord before and after pressure test can be used as a more reliable index to predict fetal distress of umbilical cord around the neck in the first months of pregnancy. Have higher clinical value.