彩色多谱勒超声观察脐动脉S/D值对评估脐带绕颈预后的临床意义

目的：探讨彩色多谱勒超声在胎儿脐带绕颈诊断中的临床价值及脐动脉S/D值测定对评估脐带绕颈预后的临床意义。方法：选择孕37～42周产前常规B超检查发现脐带绕颈209例孕产妇为脐带绕颈组,另选同期B超检查无脐带绕颈60例为对照组,两组均行彩色多谱勒超声检查。并对胎儿颈部进行观察,同时测定脐动脉S/D值、RI值,最后结合分娩方式、羊水粪染、Apgar评分进行分析。结果：（1）脐带绕颈组分娩后证实脐带绕颈205例,彩色多谱勒超声诊断符合率达98.1%。脐带绕颈组脐动脉S/D值、RI值与对照组相比,差异有统计学意义（P〈0.001）;（2）205例脐带绕颈孕产妇中,脐动脉S/D值≥3.0时羊水2度污染、新生儿Apgar评分、分娩方式等与S/D值〈3.0相比较,差异均有统计学意义（P〈0.01）。结论：彩色多谱勒超声诊断脐带绕颈准确率高,检测脐动脉S/D值对预测胎儿宫内窘迫、指导分娩方式的选择有重要参考意义。

Significance of color Doppler ultrasound test in prognosis of umbilical cord around neck by detecting umbilical artery S/D ratio

Objective:To evaluate the significance of color Doppler ultrasound test in the prognosis of umbilical cord around neck by detecting umbilical artery S/D ratio. Methods: Two hundred and nine patients who were detected as umbilical cord around neck by B ultrasound after 37-42 weeks of gestational age were recruited as umbilical cord around neck group and 60 cases without umbilical cord around neck were selected as control group. Color Doppler ultrasound test was performed on both umbilical cord around neck group and the controls to observe the cervical region,detect the umbilical artery S/D ratio and vascular resistance index (RI) of the fetus. Comprehensive information of each case including delivery mode,amniotic fluid condition and Apgar score were collected for analysis. Results: (1) In the umbilical cord around neck group,205 cases were confirmed as umbilical cord around neck at delivery which showed a diagnostic accuracy rate of 98.1% for color Doppler ultrasound. There are significant difference between the S/D ratio,RI value of the umbilical cord around neck group and that of the control group (P<0.001). (2) Comparing cases of S/D≥3.0 with that of S/D<3.0,there are significant differences between the meconium-stained degree of amniotic fluid,Apgar scores and delivery models(P<0.05).Conclusion: Color Doppler ultrasound is accurate in the diagnosis of umbilical cord around neck,S/D ratio can be significant indicator for both predicting fetal distress in uterus and choosing proper delivery model.