超声监测低体重儿的母体子宫动脉、胎儿脐动脉及大脑中动脉的作用

The Role of Ultrasound in Monitoring Maternal Uterine Artery, Fetal Umbilical Artery and Middle Cerebral Artery in Low Birth Weight Infants

摘要: 胎儿生长受限(Fetal Growth Restriction, FGR)即意味着胎儿的生长发育没有达到胎儿相应的生长潜能，在妊娠期发病率较高，在生长受限的新生儿中，围产期发病率和死亡率高出普通新生儿8倍，是新生儿发病和死亡的主要原因。胎儿生长受限又分为早发型(妊娠32周之前)和晚发型(妊娠32周及以后)，与晚发型的胎儿生长受限相比，早发型的胎儿生长受限产妇及胎儿的发病率和死亡率都比较高，值得关注的是胎儿生长受限大多集中在34周之后才能被发现，但是目前除分娩外，尚无能够逆转FGR的有效治疗方法，然而过早或过晚的分娩都会降低新生儿的存活率，而多普勒评估早已被纳入妊娠早期胎盘及胎儿疾病的预测，特别是妊娠中期的多普勒超声可以预测大多数胎儿生长受限的情况，其中子宫动脉多普勒血流参数反映了子宫胎盘血流灌注的情况，脐动脉多普勒血流参数可以有效反映胎盘与母体的血流变化，脐动脉多普勒血流参数已经被证实可以降低新生儿死亡的风险，大脑中动脉多普勒血流参数反映了胎儿脑部供血供氧的情况。

Abstract: Fetal Growth Restriction (FGR) means that the growth and development of the fetus does not reach the corresponding growth potential of the fetus, and the incidence of FGR is high during pregnancy, the perinatal morbidity and mortality rate is 8 times higher than that of normal newborn, which is the main cause of neonatal morbidity and mortality. Fetal growth restriction is further divided into early-onset (before 32 weeks gestation) and late-onset (32 weeks gestation and beyond), as com-pared with late-onset fetal growth restriction, early-onset fetal growth restriction is associated with high maternal and fetal morbidity and mortality. It should be noted that most cases of fetal growth restriction are not detected until 34 weeks after delivery, there are no effective treatments that can reverse FGR, but early or late delivery can reduce neonatal survival, and Dopler’s assessment has long been included in the prediction of placental and fetal disease in early pregnancy, in particular, Dopler ultrasound in the second trimester can predict most fetal growth restriction conditions, in which uterine artery Doppler parameters reflect uterine-placental blood flow perfusion, umbilical artery Doppler flow parameters can effectively reflect the placental and maternal blood flow changes, umbilical artery Doppler flow parameters have been proven to reduce the risk of perinatal mortality, Doppler parameters of middle cerebral artery reflect the blood and oxygen supply to the fetal brain.