胎孕20~36周胎儿多动脉血流动力学参数演变规律及临床应用探索

Evolution and Clinical Application of Fetal Polyarterial Hemodynamic Parameters in 20~36 Weeks of Gestation

摘要: 目的：测定孕20~36周孕妇UtA、UA、RA、MCA的血流动力学参数，研究此孕期UtA、UA、RA、MCA血流演变规律及临床应用探索。方法：彩色多普勒血流动力学分别测量200例孕20~36周孕妇UtA及胎儿UA、RA、MCA的PSV、EDV、RI、PI、S/D。结果：胎儿生长发育过程中UA、MCA和RA的PSV与孕周呈正相关，孕妇UtA的PSV随着孕周增加无明显改变；胎儿UA、MCA、RA、孕妇UtA的EDV与孕周呈正相关；胎儿UA、RA、孕妇UtA的RI、PI、S/D与孕周呈负相关，且组间呈正相关；胎儿MCA的RI、PI、S/D随着孕周的增加呈现先上升后下降的趋势；胎儿MCA、UA、RA、孕妇UtA的RI、PI、S/D的组间差异具有统计学意义(P < 0.01)。结论：在20~32周，UA血流参数变化为：S/D由3.40 ± 0.54逐渐下降至2.47 ± 0.53，RI由0.70 ± 0.05下降至0.58 ± 0.08，PI由1.16 ± 0.14下降至0.87 ± 0.19。MCA的S/D始终保持在3.0以上，RI保持在0.7以上，PI保持在1.2以上，并呈现出先上升后下降的规律。UtA血流参数变化为：S/D由2.34 ± 0.89下降至1.84 ± 0.26，RI由0.53 ± 0.12下降至0.44 ± 0.07，PI由0.91 ± 0.42下降至0.64 ± 0.16。RA血流参数变化为：S/D由8.38 ± 2.41下降至7.04 ± 2.34，RI由0.87 ± 0.04下降至0.84 ± 0.04，PI由2.21 ± 0.31下降至1.87 ± 0.40。且RA的RI、PI、S/D处于最高水平，UtA的RI、PI、S/D处于最低水平，MCA的的RI、PI、S/D高于UA。本文数据可用作多参数超声监测胎儿宫内发育情况的参考。

Abstract: Objective: The hemodynamic parameters of UtA, UA, RA, and MCA in pregnant women from 20 to 36 weeks of gestation were determined, and the blood flow evolution rules of UtA, UA, RA, and MCA and its clinical application were explored. Methods: PSV, EDV, RI, PI and S/D of UtA and fetal UA, RA and MCA were measured by color Doppler hemodynamics in 200 pregnant women at 20~36 weeks. Results: The PSV of UA, MCA and RA were positively correlated with gestational age during fetal growth and development. The PSV of UtA did not change with gestational age. The EDV of fetal UA, MCA, RA and UtA were positively correlated with gestational age. The RI, PI and S/D of fetal UA, RA and UtA in pregnant women were negatively correlated with gestational age, and positively correlated with each other. The RI, PI and S/D of fetal MCA increased first and then decreased with the increase of gestational age. There were significant differences in MCA, UA, RA of fetus and RI, PI, S/D of UtA of pregnant women (P < 0.01). Conclusion: During 20~32 weeks, UA blood flow parameters decreased from 3.40 ± 0.54 to 2.47 ± 0.53, RI from 0.70 ± 0.05 to 0.58 ± 0.08, PI from 1.16 ± 0.14 to 0.87 ± 0.19. MCA S/D is always above 3.0, RI is above 0.7, PI is above 1.2, and it shows a law of first rising and then falling. UtA blood flow parameters decreased from 2.34 ± 0.89 to 1.84 ± 0.26, RI from 0.53 ± 0.12 to 0.44 ± 0.07, PI from 0.91 ± 0.42 to 0.64 ± 0.16. RA blood flow parameters decreased from 8.38 ± 2.41 to 7.04 ± 2.34, RI from 0.87 ± 0.04 to 0.84 ± 0.04, PI from 2.21 ± 0.31 to 1.87 ± 0.40. The RI, PI, and S/D of RA were the highest, the RI, PI, and S/D of UtA were the lowest, and the RI, PI, and S/D of MCA were higher than those of UA. The data in this paper can be used as a reference for monitoring fetal intrauterine development by multi-parameter ultrasound.