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彩色多普勒监测正常妊娠和胎儿宫内生长受限情况下子宫 - 胎盘 - 胎儿循环的变化。

Color Doppler monitoring of changes of utero-placental-fetal circulation in normal pregnancy and intrauterine growth retardation.

作者信息

Xu J, Wen L, Ma T, Zhang Y, Zhang Q, Gao S, Zhao M, Wu H, Hu J

机构信息

Department of Obstetrics Gynecology, Tongji Hospital, Tongji Medical University, Wuhan.

出版信息

J Tongji Med Univ. 1997;17(2):110-4. doi: 10.1007/BF02888247.

Abstract

The utero-placental-fetal circulation (UPFC) of 150 subjects during second and third trimester was examined by using color Doppler. Of them 89 were normal woman and 58 were patients with intrauterine growth retardation IUGR). Our results showed that UPFC was increased gradually during normal pregnant period. In IUGR patients it was revealed that TAV and Q of UmA, UmV and UtA decreased at 20th week of gestation, especially after 30th week. PI, RI and S/D ratio of UmA were increased, but TAV, Q of UmA and UmV were markly reduced, so was UtA. PI were increased, but the changes of RI, S/D ratio in UtA were not significant. Hemodynamical findings of UmA, UmV and UtA were abnormal in 92.53% of IUGR patients. Only 81.03% present abnormal S/D ratio of UmA (P < 0.01) and the difference was statistically significant. Maternal serum E3, HPL level in IUGR were significantly lower than that of the normal. 6KP level was reduced, TXB2/6KP ratio was significantly increased. TXB2/6KP ratio was markedly related with TAV, Q of UmA, UmV and UtA. Our results suggested that using color doppler ultrasound for examination of hemodynamical changes of UmA, UmV and UtA could revealed UPFC function directly. It is one of the best methods for monitoring IUGR and might be used for early diagnosis of IUGR. The main pathophysiological changes of IUGR were UPFC obstruction and placental disfunction.

摘要

采用彩色多普勒对150例孕中晚期孕妇的子宫 - 胎盘 - 胎儿循环(UPFC)进行检测。其中89例为正常孕妇,58例为胎儿宫内生长受限(IUGR)患者。结果显示,正常孕期UPFC呈逐渐升高趋势。IUGR患者在妊娠20周时,尤其是30周后,脐动脉(UmA)、脐静脉(UmV)和子宫动脉(UtA)的血流时间平均流速(TAV)及血流量(Q)降低。UmA的搏动指数(PI)、阻力指数(RI)及收缩期与舒张期血流速度比值(S/D)升高,而UmA、UmV的TAV及Q显著降低,UtA亦如此。UtA的PI升高,但RI、S/D比值变化不明显。92.53%的IUGR患者UmA、UmV及UtA血流动力学表现异常。仅81.03%的患者UmA的S/D比值异常(P < 0.01),差异具有统计学意义。IUGR患者母血中雌三醇(E3)、人胎盘催乳素(HPL)水平显著低于正常孕妇。6 - 酮 - 前列腺素F1α(6KP)水平降低,血栓素B2/6 - 酮 - 前列腺素F1α(TXB2/6KP)比值显著升高。TXB2/6KP比值与UmA、UmV及UtA的TAV及Q显著相关。结果提示,应用彩色多普勒超声检测UmA、UmV及UtA血流动力学变化可直接反映UPFC功能,是监测IUGR的最佳方法之一,可用于IUGR的早期诊断。IUGR主要的病理生理改变为UPFC受阻及胎盘功能障碍。

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