标题：胎儿频谱多普勒联合胎儿生物物理学评分对胎儿宫内缺氧的诊断价值

      作者：张凌，王凤，何芳，张敏楠，孟临侠    宝鸡市中医医院超声科，陕西 宝鸡 721001

      卷次： 2019年30卷5期

      【摘要】 目的 探讨应用彩色多普勒超声血流检测及生物物理评分 (BPS)诊断胎儿宫内缺氧的价值。方法 将2015年3月至2017年3月宝鸡市中医医院妇产科收治的60例胎儿宫内窘迫孕妇为研究组，并选择60例正常孕妇为对照组，均采用彩色多普勒超声检测大脑中动脉(MCA)、静脉导管(DV)、脐动脉(UA)血流指数，采用B超获得胎儿BPS评分，比较两组孕妇MCA、DV、UA血流指数和BPS评分的差异，并分析超声血流检测、BPS、联合检测诊断胎儿宫内窘迫的价值。结果 研究组孕妇BPS评分低于对照组[(4.02±1.92)分 vs (6.32±2.59)分]，MCAPI、MCAR1、MCAS/D低于对照组[(1.12±0.23) vs (1.85±0.45)、(0.63±0.04) vs (0.79±0.06)、(3.02±0.25) vs (4.97±0.28)]，UAPI、UARI、UAS/D、DVPIV、DVPVIV高于对照组[(1.28±0.26) vs (0.81±0.21)、(0.76±0.09) vs (0.52±0.03)、(4.03±0.18) vss (2.06±0.22)、(0.85±0.03) vs (0.60±0.03)、(0.78±0.06) vs (0.50±0.04)]，差异均有统计学意义(P<0.05)；研究组孕妇BPS、超声血流检测胎儿宫内窘迫的阳性率高于对照组[58.33% vs 20.00%、70.00% vs 25.00%]，差异均有统计学意义(P<0.05)；研究组联合检测阳性率为88.33%，高于BPS单独检测的58.33%和超声血流检测的70.00%，差异均有统计学意义(P<0.05)。BPS、超声血流检测、联合检测诊断胎儿宫内窘迫的曲线下面积(AUC)分别为 0.761 (95%CI：0.364~0.951)、0.803 (95%CI：0.271~0.806)、0.902 (95%CI：0.135~0.947)，灵敏度和特异度分别为73.16%、54.61%；81.64%、71.52%；92.34%、95.37%。结论 彩色多普勒超声血流检测诊断胎儿宫内窘迫的价值高于生物物理评分，联合检测可提高胎儿宫内窘迫的诊断价值。
      【关键词】 彩色多普勒超声；血流检测；生物物理评分；胎儿宫内缺氧；诊断价值
      【中图分类号】 R714.5 【文献标识码】 A 【文章编号】 1003—6350（2019）05—616—03V

alue of fetal spectrum Doppler combined with fetal biophysical score in the evaluation of fetal intrauterinehypoxia.
ZHANG Ling, WANG Feng, HE Fang, ZHANG Min-nan, MENG Lin-xia. Department of Ultrasound, BaojiHospital of Traditional Chinese Medicine, Baoji 721001, Shaanxi, CHINA
【Abstract】 Objective To evaluate the value of color Doppler flow imaging and biophysical score (BPS) inevaluating intrauterine hypoxia. Methods From March 2015 to March 2017, 60 pregnant women with intrauterine dis-tress were selected as the study group, and 60 normal pregnant women were selected as the control group. The middle ce-rebral artery (MCA), venous catheter (DV), umbilical artery (UA) blood flow indexes were detected by color Doppler ul-trasound. The fetal BPS score was obtained by B ultrasound. The differences in MCA, DV, UA blood flow indexes, andBPS score between the two groups were evaluated, and the value of ultrasonic blood flow detection, BPS, combined de-tection of fetal distress in the diagnosis of fetal distress was analyzed. Results The BPS score of the study group waslower than that of the control group: (4.02 ± 1.92) vs (6.32 ± 2.59); MCAPI, MCAR1, MCAS/D were significantly lower:(1.12±0.23) vs (1.85±0.45), (0.63±0.04) vs (0.79±0.06), (3.02±0.25) vs (4.97±0.28); UAPI, UARI, UAS/D, DVPIV, DVPVIV weresignificantly higher: (1.28±0.26) vs (0.81±0.21), (0.76±0.09) vs (0.52±0.03), (4.03±0.18) vs (2.06±0.22), (0.85±0.03) vs(0.60±0.03), (0.78±0.06) vs (0.50±0.04); the differences were all statistically significant (P<0.05). The positive rate of fe-tal distress in BPS and ultrasonic blood flow detection in the study group was higher than that of the control group:58.33% vs 20.00%, 70.00% vs 25.00%, P<0.05; The positive rate of combined detection in the study group was 88.33%,which was higher than 58.33% for BPS and 70.00% for ultrasound blood flow detection (P<0.05). The area (AUC) ofBPS, ultrasound, and combined detection of fetal distress was 0.761 (95% CI: 0.364-0.951), 0.803 (95% CI:0.271-0.806), and 0.902 (95% CI: 0.135-0.947) respectively. The sensitivity and specificity were 73.16%, 54.61%;81.64%, 71.52%; 92.34%, 95.37%, respectively. Conclusion The value of color Doppler ultrasound in the diagnosisof fetal distress is higher than that of biophysical score. Combined detection can improve the diagnostic value of fetaldistress.
      【Key words】 Color Doppler ultrasound; Blood flow detection; Biophysical score (BPS); Fetal intrauterine hypox-ia; Diagnostic value