超声血流参数诊断脐带绕颈胎儿呼吸窘迫的价值

Value of ultrasound blood flow parameters in diagnosis of fetal respiratory distress with umbilical cord around the neck

  • 摘要:
    目的  探讨超声检测脐动脉(UA)和大脑中动脉(MCA)预测妊娠晚期脐带绕颈患儿呼吸窘迫的临床价值。
    方法  选取产检和足月分娩符合纳入和排除标准的385例晚期妊娠孕妇为研究对象,根据妊娠结局和胎儿窘迫诊断标准,将孕妇分成窘迫组(n=102)和正常组(n=283)。比较2组受试者UA和MCA血流动力学指标水平,应用受试者工作特征(ROC)曲线分析差异有统计学意义的指标,并比较其诊断效能。
    结果  窘迫组UA阻力指数(UA-RI)值高于正常组,MCA阻力指数(MCA-RI)值低于正常组,差异有统计学意义(P < 0.05);窘迫组MCA和UA的RI比值(UA/MCA-RI)高于正常组,差异有统计学意义(P < 0.05)。根据ROC曲线,UA-RI诊断的临界值为0.67,对应的敏感度为74.51%,特异度为85.16%,ROC曲线下面积为0.798(95%CI为0.750~0.846);MCA-RI诊断的临界值为0.86,对应的敏感度为77.45%,特异度为84.45%,ROC曲线下面积为0.802(95%CI为0.758~0.846);UA/MCA-RI诊断的临界值为0.71,对应的敏感度为90.20%,特异度为91.87%,ROC曲线下面积为0.902(95%CI为0.832~0.972)。
    结论  UA-RI和MCA-RI对胎儿窘迫临床诊断具有重要价值,且联合检测UA/MCA-RI的诊断效能更高。

     

    Abstract:
    Objective  To explore the clinical value of ultrasound detection of umbilical artery (UA) and middle cerebral artery (MCA) in predicting respiratory distress in children with umbilical cord around neck in late pregnancy.
    Methods  A total of 385 pregnant women with late pregnancy who met inclusion and exclusion criteria were selected as research subjects. According to the pregnancy outcome and diagnostic criteria for fetal distress, the pregnant women were divided into distress group (n=102) and normal group (n=283). The hemodynamic levels of UA and MCA were compared between the two groups, the Receiver Operating Characteristic (ROC) curve was used to analyze the indicators with statistically significant differences, and their diagnostic efficacy was compared.
    Results  The value of UA resistance index (UA-RI) in the distress group was significantly higher than that in the normal group, and the value of MCA resistance index (MCA-RI) in the distress group was significantly lower than that in the normal group (P < 0.05). The ratio of RI of MCA and UA(UA/MCA-RI)in the distress group was higher than that in the normal group (P < 0.05). According to ROC curve, the critical value of UA-RI was 0.67, the corresponding sensitivity was 74.51%, the specificity was 85.16%, and the area under the ROC curve was 0.798 (95%CI, 0.750 to 0.846). The critical value of MCA-RI was 0.86, the corresponding sensitivity was 77.45%, the specificity was 84.45%, and the area under the ROC curve was 0.802 (95%CI, 0.758 to 0.846). The critical value of UA/MCA-RI was 0.71, the corresponding sensitivity was 90.20%, the specificity was 91.87%, and area under the ROC curve was 0.902 (95%CI, 0.832 to 0.972.
    Conclusion  UA-RI and MCA-RI are of great value in the clinical diagnosis of fetal distress, and the combined detection of UA/MCA-RI has higher diagnostic efficiency.

     

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