标题：大脑中动脉及脐动脉S/D、NST预测胎儿宫内窘迫的临床价值

      作者：郑秀珠 1，罗晓玲 1，罗冠达 2    惠东县人民医院产科 1、药剂科 2，广东 惠州 516300

      卷次： 2021年32卷24期

      【摘要】 目的 探究大脑中动脉(MCA)、脐动脉(UA)收缩期与舒张期流速比值(S/D)、无刺激胎心监护(NST)对胎儿宫内窘迫的预测价值。方法 选择2020年1月至2021年4月在惠东县人民医院产检的200例孕妇作为研究对象，根据胎儿宫内窘迫的诊断标准将所有产妇分为宫内窘迫组73例和非宫内窘迫组127例，两组孕妇均在产前进行MCA、UA血流检测和NST监测。比较两组孕妇的MCA、UA的S/D比值和NST监测结果。比较不同MCA、UA的S/D比值、不同NST监测结果孕妇的Apgar评分以及宫内窘迫发生率。比较MCA S/D值、UA S/D值、NST监测单项以及三者联合诊断胎儿宫内窘迫的灵敏度、特异度和准确度。结果 宫内窘迫组孕妇的MCA S/D值为2.87±0.61，明显低于非宫内窘迫组的3.81±0.79，UA S/D值为3.46±0.63，明显高于非宫内窘迫组的2.74±0.55，差异均有统计学意义(P<0.05)；NST监测结果显示，宫内窘迫组孕妇中无反应型的比例为61.64%，明显高于非宫内窘迫组的18.90%，差异有统计学意义(P<0.05)；MCA S/D值<3孕妇的新生儿Apgar评分为(6.58±1.33)分，明显低于MCAS/D值≥3孕妇的(8.08±1.57)分，MCA S/D值<3孕妇的宫内窘迫发生率为65.33%，明显高于MCA S/D值≥3孕妇的19.20%，差异均有统计学意义(P<0.05)；UA S/D值≥3孕妇的新生儿Apgar评分为(6.67±1.41)分，明显低于UA S/D值<3孕妇的(8.11±1.67)分，UA S/D值≥3孕妇的宫内窘迫发生率为63.75%，明显高于UA S/D值<3孕妇的18.33%，差异均有统计学意义(P<0.05)；无反应型孕妇的新生儿Apgar评分为(6.47±1.33)分，明显低于反应型的(8.04±1.51)分，宫内窘迫发生率为65.22%，明显高于反应型的21.37%，差异均有统计学意义(P<0.05)；MCA、UA S/D值和NST三者联合诊断胎儿宫内窘迫的灵敏度、特异度和准确度分别为87.50%、92.19%、90.50%，明显高于各单项检查，差异均有统计学意义(P<0.05)。结论 宫内窘迫发生时，胎儿MCA、UA的血流参数均会出现异常改变，NST监测结果多表现为无反应型。MCA、UAS/D值联合NST能够较为准确地对胎儿宫内窘迫进行预测。
      【关键词】 宫内窘迫；无刺激胎心监护；大脑中动脉；脐动脉；血流频谱参数；预测价值
      【中图分类号】 R714.43 【文献标识码】 A 【文章编号】 1003—6350（2021）24—3205—04

Diagnostic value of S/D of middle cerebral artery and umbilical artery, no stimulation of fetal heart ratemonitoring in predicting fetal distress.
ZHENG Xiu-zhu 1, LUO Xiao-ling 1, LUO Guan-da 2. Department of Obstetrics 1,Department of Pharmacy 2, Huidong People's Hospital, Huizhou 516300, Guangdong, CHINA
【Abstract】 Objective To research the diagnostic value of systolic and diastolic velocity ratio (S/D) of middlecerebral artery (MCA) and umbilical artery (UA) and no stimulation of fetal heart rate monitoring (NST) in predicting fe-tal distress. Methods A total of 200 pregnant women who underwent prenatal examination in Huidong People's Hospi-tal from January 2020 to March 2021 were selected as the research objects. According to the diagnostic criteria of intra-uterine fetal distress, all pregnant women were divided into intrauterine distress group (73 cases) and non-intrauterine distressgroup (127 cases). Two groups of pregnant women were tested for MCA, UA blood flow, and NST before delivery. The S/D ra-tio of MCA and UA and the monitoring results of NST were compared between the two groups. The Apgar score, distributionand incidence of intrauterine distress of pregnant women with different S/D ratios of MCA and UA, different NST monitoringresults were compared. The sensitivity, specificity, and accuracy of MCA S/D ratio, UA S/D ratio, NST monitoring andtheir combination in the diagnosis of fetal distress were compared. Results In the intrauterine distress group, the MCAS/D value was 2.87±0.61, which was significantly lower than 3.81±0.79 in non-intrauterine distress group; the UA S/Dvalue was 3.46±0.63, which was significantly higher than 2.74±0.55 in non-intrauterine distress group; the proportion ofnonresponsive type in intrauterine distress group (61.64%) was significantly higher than that in non-intrauterine distressgroup (18.90% ); the differences were statistically significant (P<0.05). The neonatal Apgar score of pregnant womenwith MCA S/D value<3 was (6.58±1.33) points, which was significantly lower than (8.08±1.57) points of the pregnantwomen with MCA S/D value≥3; the incidence of intrauterine distress was 65.33%, significantly higher than 19.20% ofpregnant women with MCA S/D≥3; the differences were statistically significant (P<0.05). The newborn Apgar score ofpregnant women with UA S/D≥3 was (6.67±1.41) points, which was significantly lower than (8.11±1.67) points of preg-nant women with UA S/D<3; the incidence of intrauterine distress was 63.75% , significantly higher than 18.33% forpregnant women with UA S/D value<3; the differences were statistically significant (P<0.05). The Apgar score of new-