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目的研究结合新生儿脐血血气分析结果评价彩色多普勒超声诊断胎儿窘迫敏感性和特异性,以提高胎儿窘迫临床诊断准确率。方法收集我院2009年3月-2012年9月13000份孕妇分娩前24h内的彩色多普勒超声检查资料,鉴别是否存在胎儿窘迫,评价彩色多普勒超声检测胎儿脐动脉(UA)及大脑中(MCA)S/D、阻力指数RI、搏动指数(PI)对临床诊断胎儿窘迫的灵敏性和特异性,对产前彩色多普勒超声检测结果与新生儿脐血血气的相关性进行分析。结果胎儿窘迫组脐动脉阻力指标明显高于正常对照组(P<0.05),而胎儿大脑中动脉阻力指标均低于正常对照组(P<0.05)。而且胎儿脐动脉和大脑中动脉阻力指标之比值更敏感,当(RIUA/MCA)>1.00、(PIUA/MCA)>1.00、(SUA/DUA)/(SMCA/DMCA)>0.61提示胎儿窘迫的敏感性和特异性分别为88.5%、94.5%。结论胎儿窘迫时胎儿血流动力学会产生明显的变化,彩色多普勒超声检测胎儿脐动脉和大脑中动脉指标可以比较准确地了解胎儿宫内状况,胎儿脐动脉和大脑中动脉阻力指标之比值更预测胎儿宫内缺氧具有特异性,为胎儿窘迫诊断提供了一种较好的方法,可假阳性率,具有一定的临床价值。
Objective To evaluate the sensitivity and specificity of color Doppler ultrasound in the diagnosis of fetal distress based on the results of cord blood gas analysis in neonates to improve the accuracy of clinical diagnosis of fetal distress. Methods The data of color Doppler echocardiography in 13,000 pregnant women before delivery in our hospital from March 2009 to September 2012 were collected to identify the presence of fetal distress and to evaluate the diagnostic value of color Doppler ultrasonography in fetal umbilical artery (UA) and brain (MCA) S / D, resistance index RI and pulsatility index (PI) to the clinical diagnosis of fetal distress were analyzed. The correlation between prenatal color Doppler ultrasound and neonatal umbilical blood gas was analyzed . Results The resistance index of umbilical artery in fetal distress group was significantly higher than that in normal control group (P <0.05), while the resistance index of fetal middle cerebral artery was lower than that in normal control group (P <0.05). (RIUA / MCA)> 1.00, (PIUA / MCA)> 1.00, and (SUA / DUA) / (SMCA / DMCA)> 0.61 suggest that the sensitivity of fetal distress is higher than that of fetal umbilical artery and middle cerebral artery resistance index Sexual and specificity were 88.5%, 94.5%. Conclusions Fetal hemodynamics can be significantly changed in fetal distress. The detection of fetal umbilical artery and middle cerebral artery by color Doppler ultrasonography can more accurately understand the intrauterine conditions, and the ratio of fetal umbilical artery and middle cerebral artery resistance index is more Prediction of fetal intrauterine hypoxia has specificity for the diagnosis of fetal distress provides a better method, the false positive rate, has some clinical value.