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目的评价血液动力学指标预测未足月胎膜早破胎儿-胎盘系统动脉血流测量评价胎儿宫内情况的价值。方法用彩色多普勒超声检测279例未足月胎膜早破分娩的孕妇胎儿脐动脉(UmA)、大脑中动脉(MCA)、肾动脉(RA)的血流速度波型(FVWs),并且分娩时测定新生儿脐动脉血气及胎盘送病理检查。结果本研究将UtA、UmA、RA及MCA的RI值与脐动脉血pH、PO2、PCO2值作了相关性分析,UmA的RI值及S/D与PO2、pH值呈负相关,与PCO2呈正相关,MCA则正好与前两者相反。当胎膜早破尤其合并胎盘绒毛膜羊膜炎时,通过神经体液调节,母体-胎盘-胎儿循环的血液动力学有改变,胎盘出现炎症改变时脐动脉S/D的变化有统计学相关意义。结论未足月胎膜早破胎儿-胎盘系统动脉血流测量,胎儿血液动力学变化与缺氧及酸碱平衡失调呈良好相关性,可预测胎儿缺氧及酸中毒的程度。胎盘出现炎症改变时脐动脉S/D的变化有统计学相关意义。
OBJECTIVE: To evaluate the value of hemodynamics in predicting the status of intrauterine fetal umbilical cord blood (fetal-placental system arterial blood flow) in premature rupture of membranes. Methods Fetal umbilical artery (UmA), middle cerebral artery (MCA) and renal artery (RA) blood flow velocity waveforms (FVWs) were measured by color Doppler sonography in 279 pregnant women without full-term premature rupture of membranes. Determination of neonatal umbilical arterial blood gas and placenta during delivery for pathological examination. Results In this study, RI values of UtA, UmA, RA and MCA were correlated with umbilical arterial blood pH, PO2 and PCO2 values. RI and S / D of UmA were negatively correlated with PO2 and pH, Related, MCA is exactly the opposite of the former two. When the premature rupture of membranes, especially in combination with placental chorioamnionitis, changes in hemodynamics of the maternal-placenta-fetal circulation through neurohumoral regulation have statistically significant implications for changes in the S / D of umbilical arteries as placental inflammation changes. Conclusions Fetal - placental system arterial blood flow measurement in preterm premature rupture of membranes has not been reported. There is a good correlation between fetal hemodynamic changes and hypoxia and acid-base balance disorders, which can predict fetal hypoxia and acidosis. Changes in the placenta of umbilical artery S / D changes have statistical significance.