高原地区高危产妇胎儿宫内窘迫超声诊断的价值分析

doi:10.11958/20230408

天津医药 ›› 2023, Vol. 51 ›› Issue (12): 1374-1377.doi: 10.11958/20230408

高原地区高危产妇胎儿宫内窘迫超声诊断的价值分析

赵永峰¹(), 甘国财¹, 王雪¹, 赵旭², 马淑梅¹, 李彩琴¹, 张成¹

1.青海大学附属医院超声科（邮编810001）
2.北京大学民航临床医学院妇产科

收稿日期:2023-03-24 修回日期:2023-06-29 出版日期:2023-12-15 发布日期:2023-12-22
作者简介:赵永峰（1980），男，主治医师，主要从事高原地区高危妊娠方面研究。E-mail：zmjs20230306@163.com
基金资助:
青海省医药卫生科技项目(2020-wjzd-54)

Diagnostic value of ultrasound diagnosis of fetal intrauterine distress in high-risk puerperae in plateau areas

ZHAO Yongfeng¹(), GAN Guocai¹, WANG Xue¹, ZHAO Xu², MA Shumei¹, LI Caiqin¹, ZHANG Cheng¹

1. Department of Ultrasound, Qinghai University Affiliated Hospital, Xining 810001, China
2. Gynaecology and obstetrics, School of Civil Aviation Clinical Medicine, Peking University

Received:2023-03-24 Revised:2023-06-29 Published:2023-12-15 Online:2023-12-22

赵永峰, 甘国财, 王雪, 赵旭, 马淑梅, 李彩琴, 张成. 高原地区高危产妇胎儿宫内窘迫超声诊断的价值分析[J]. 天津医药, 2023, 51(12): 1374-1377.

ZHAO Yongfeng, GAN Guocai, WANG Xue, ZHAO Xu, MA Shumei, LI Caiqin, ZHANG Cheng. Diagnostic value of ultrasound diagnosis of fetal intrauterine distress in high-risk puerperae in plateau areas[J]. Tianjin Medical Journal, 2023, 51(12): 1374-1377.

摘要/Abstract

摘要：

目的探讨彩色多普勒超声对青海高原地区高危产妇胎儿宫内窘迫（FIUD）诊断的价值。方法选取青海高原地区和北京平原地区孕妇各130例，根据FIUD发生情况分为高原窘迫组47例、高原正常组83例、平原窘迫组31例、平原正常组99例。所有对象均在分娩前行大脑中动脉（MCA）和脐动脉（UA）血流检测，计算脑-胎盘比（CPR）。比较高原地区和平原地区高危产妇FIUD发生率；比较4组胎儿出生孕周、出生体质量、剖宫产率和MCA、UA血流频谱参数水平；受试者工作特征（ROC）曲线分析彩色多普勒超声多参数预测高原地区高危产妇FIUD的价值。结果高原地区高危产妇FIUD发生率和重度FIUD发生率均高于平原地区（分别为36.15% vs. 23.85%和13.85% vs. 4.62%；P<0.05）；与高原窘迫组比较，高原正常组和平原窘迫组的出生孕周、出生体质量增加、MCA的PI、RI、S/D值和CPR升高，UA的PI、RI和S/D降低（P<0.05）；ROC结果显示，以UA中S/D指标诊断高原地区高危产妇FIUD的整体性能优势最明显，其中MCA中RI指标诊断敏感度最高，CPR诊断特异度最高（P<0.05）。结论彩色多普勒超声对高原地区高危产妇FIUD具有较好的诊断价值，可作为临床筛查FIUD的有效手段。

关键词: 胎儿窘迫, 超声检查，产前, 超声检查，多普勒，彩色, 脑动脉, 脐动脉, 妊娠，高危, 高原地区

Abstract:

Objective To explore the diagnostic value of color Doppler ultrasound for fetal intrauterine distress (FIUD) in high-risk puerperae in plateau areas. Methods A total of 130 puerperae in plateau areas and 130 puerperae in plain areas were enrolled. According to presence or absence of FIUD in different areas, they were divided into the plateau distress group (47 cases), the plateau normal group (83 cases), the plain distress group (31 cases) and the plain normal group (99 cases). All cases underwent blood flow detection of middle cerebral artery (MCA) and umbilical artery (UA) before delivery, and cerebral -placental ratio (CPR) was calculated. The incidence of FIUD was compared between high-risk puerperae in plateau area and in plain area. Gestational age, birth weight, cesarean section rate and blood spectrum parameters of MCA and UA were compared between the four groups. The predictive value of color Doppler ultrasound parameters for FIUD was analyzed by receiver operating characteristic (ROC) curves. Results The incidence rates of FIUD and severe FIUD were higher in patients of plateau areas than those in plain areas (36.15%, 13.85% vs. 23.85%, 4.62%, P<0.05). Compared with the plateau distress group, gestational age and birth weight were increased in the plateau normal group and the plain distress group (P<0.05). Compared with the plateau distress group, PI, RI, S/D and CPR of MCA were increased, while PI, RI and S/D of UA were decreased in the plateau normal group and the plain distress group (P<0.05). Results of ROC curve analysis showed that overall performance advantage of S/D of UA was the most obvious in the diagnosis of FIUD in high-risk puerperae in plateau areas. The diagnostic sensitivity of RI of MCA was the highest, and the diagnostic specificity of CPR was the highest (P<0.05). Conclusion Color Doppler ultrasound has good diagnostic value for FIUD in high-risk puerperae in plateau areas, which can be applied as an effective clinical screening means for FIUD.

Key words: fetal distress, ultrasound examination, prenatal, ultrasound examination, Doppler, color, cerebral artery, umbilical artery, pregnancy, high risk, plateau area

中图分类号:

R714.5

图/表 5

参考文献 20

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组别	n	年龄/岁	孕周/周	产次/次	BMI/（kg/m²）
高原窘迫组	47	28.49±2.01	34.26±0.81	1.58±0.23	24.38±0.65
高原正常组	83	28.37±1.62	33.90±0.96	1.46±0.19	24.27±0.54
平原窘迫组	31	28.94±2.52	34.08±1.05	1.52±0.27	24.45±0.61
平原正常组	99	28.01±2.42	34.11±0.93	1.49±0.30	24.34±0.73
F		1.086	1.623	2.372	1.823

组别	n	年龄/岁	孕周/周	产次/次	BMI/（kg/m²）
高原窘迫组	47	28.49±2.01	34.26±0.81	1.58±0.23	24.38±0.65
高原正常组	83	28.37±1.62	33.90±0.96	1.46±0.19	24.27±0.54
平原窘迫组	31	28.94±2.52	34.08±1.05	1.52±0.27	24.45±0.61
平原正常组	99	28.01±2.42	34.11±0.93	1.49±0.30	24.34±0.73
F		1.086	1.623	2.372	1.823

组别	n	出生孕周/ 周	出生体质量/kg	生产方式
组别	n	出生孕周/ 周	出生体质量/kg	顺产	剖宫产
高原窘迫组	47	37.02±1.64	2.77±0.10	19（40.43）	28（59.57）
高原正常组	83	38.67±0.69^a	3.47±0.16^a	67（80.72）^a	16（19.28）^a
平原窘迫组	31	37.77±1.50^a	3.07±0.13^a	24（77.42）^a	7（22.58）^a
平原正常组	99	38.95±1.11^b	3.68±0.09^b	89（89.90）^b	10（10.10）^b
F或χ²		19.122^＊＊	419.351^＊＊	44.798^＊＊

组别	n	出生孕周/ 周	出生体质量/kg	生产方式
组别	n	出生孕周/ 周	出生体质量/kg	顺产	剖宫产
高原窘迫组	47	37.02±1.64	2.77±0.10	19（40.43）	28（59.57）
高原正常组	83	38.67±0.69^a	3.47±0.16^a	67（80.72）^a	16（19.28）^a
平原窘迫组	31	37.77±1.50^a	3.07±0.13^a	24（77.42）^a	7（22.58）^a
平原正常组	99	38.95±1.11^b	3.68±0.09^b	89（89.90）^b	10（10.10）^b
F或χ²		19.122^＊＊	419.351^＊＊	44.798^＊＊

组别	n	MCA			UA			CPR
组别	n	PI	RI	S/D	PI	RI	S/D	CPR
高原窘迫组	47	1.32±0.16	0.61±0.04	4.02±0.65	0.94±0.10	0.68±0.06	2.55±0.29	1.24±0.36
高原正常组	83	1.72±0.11^a	0.72±0.04^a	4.75±0.66^a	0.69±0.04^a	0.56±0.04^a	2.10±0.14^a	1.69±0.37^a
平原窘迫组	31	1.54±0.21^a	0.84±0.06^a	4.42±0.62^a	0.82±0.10^a	0.51±0.03^a	2.30±0.50^a	1.58±0.45^a
平原正常组	99	1.91±0.13^b	0.92±0.04^b	4.95±0.43^b	0.62±0.04^b	0.47±0.05^b	2.04±0.10^b	1.95±0.33^b
F		120.608^＊＊	416.610^＊＊	19.493^＊	166.278^＊＊	120.051^＊＊	34.559^＊＊	25.628^＊＊

高原地区高危产妇胎儿宫内窘迫超声诊断的价值分析

Diagnostic value of ultrasound diagnosis of fetal intrauterine distress in high-risk puerperae in plateau areas

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指标		AUC	AUC 95%CI	敏感度	特异度	约登指数	截断值
MCA	PI	0.822	0.727~0.917	78.72%（37/47）	86.74%（72/83）	0.655	1.43
	RI	0.824	0.750~0.899	85.10%（40/47）	74.69%（62/83）	0.598	0.63
	S/D	0.816	0.742~0.890	76.59%（36/47）	89.15%（74/83）	0.657	0.21
UA	PI	0.813	0.710~0.916	74.46%（35/47）	85.54%（71/83）	0.600	0.76
	RI	0.825	0.739~0.912	82.97%（39/47）	92.77%（77/83）	0.757	0.63
	S/D	0.886	0.821~0.951	76.59%（36/47）	90.36%（75/83）	0.669	2.34
CPR		0.871	0.806~0.935	72.34%（34/47）	96.38%（80/83）	0.687	0.77

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