目的 探讨脐带绕颈深度与大脑中动脉(MCA)及脐动脉(UA)血流参数的关系.方法 选取孕晚期脐带绕颈胎儿139胎及正常胎儿28胎.采用多普勒超声检测胎儿MCA及UA的收缩期最大速度/舒张最小速度(S/D)、阻力指数(RI)、搏动指数(PI),并分析脐带绕颈胎儿压迹深度与MCA、UA血流参数的相关性.结果 脐带绕颈胎儿压迹深度与MCA的S/D、RI、PI呈正相关(绕颈1周r=0.32、0.32、0.35,绕颈2周r=0.71、0.69、0.53;P均＜0.05),与UA的S/D、RI、PI无相关性.脐带绕颈胎儿与正常胎儿UA血流参数差异无统计学意义(P均＞0.05),脐带绕颈1周压迹深度≥0.80 cm及脐带绕颈2周及以上胎儿MCA的S/D、RI、PI均高于正常胎儿(P均＜0.05).与正常胎儿比较,脐带绕颈2周胎儿的剖宫产率明显增高,脐带绕颈1周且压迹深度≥0.80 cm的胎儿胎心监护异常率升高,第二产程时间延长,差异均有统计学意义(P均＜0.05).结论 孕晚期脐带绕颈胎儿的MCA血流参数较UA更敏感,绕颈1周压迹深度≥0.80 cm可能引起胎儿宫内缺氧.%Objective To investigate the correlation value between the impression depth of umbilical cord around neck and the blood flow indexes of middle cerebral artery (MCA) and umbilical artery (UA) in fetus.Methods Totally 139 late pregnancy fetuses of umbilical cord around neck and 28 normal fetuses were enrolled in the study.The systolic maximum velocity/diastolic minimum velocity (S/D),resistence index (RI),pulsatility index (PI) of MCA and UA in fetuses were measured by Doppler ultrasound,and the correlation of the pressure trace depth with MCA and UA blood flow parameters were analyzed.Results The pressure trace depth of umbilical cord around neck and the S/D,RI,PI of MCA were positively correlated (one round of umbilical cord around neck,r=0.32,0.32,0.35,two or more rounds of umbilical cord around neck,r=0.71,0.69,0.53,all P＜0.05).The pressure trace depth of umbilical cord around neck and the S/D,RI,PI of UA had no correlation.Compared with normal fetuses,the parameters of UA had no significant differences in fetuses with umbilical cord around neck (all P＞0.05).The S/D,RI,PI of MCA in fetuses with pressure trace depth ≥0.80 cm and fetuses with two or more rounds of umbilical cord around neck were higher than those of normal fetuses (all P＜0.05).Fetuses with two or more rounds of umbilical cord around neck had obviously increased cesarean rate compared with normal fetuses.Compared with normal fetuses,the fetuses with pressure trace depth ≥0.80 cm had increased abnormal fetal heart rate,prolonged labor time during the second stage (all P＜0.05).Conclusion In late pregnancy fetuses with umbilical cord around neck,the blood flow parameters of MCA are more sensitive than those of UA.The pressure trace depth ≥ 0.80 cm may lead to intrauterine fetal anoxia.
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