項宇識

[摘要] 目的 該研究檢測孕中晚期胎兒臍靜脈及靜脈導管的血流速度和血流量，以彩色多普勒超聲輔助判定胎兒的發(fā)育生長的水平。 方法 對2013年10月—2014年10月產(chǎn)前檢查的正常妊娠17～40周的健康孕婦60例，應用彩色多普勒超聲檢探測胎兒一般發(fā)育狀況的同時檢測胎兒臍靜脈及其末支靜脈導管的管腔內(nèi)徑、血流速度及血流量。 結(jié)果 妊娠中期與妊娠晚期胎兒的臍靜脈和靜脈導管的各項血流參數(shù)的均值進行t檢驗，差異有統(tǒng)計學意義（P<0.001）。妊娠中、晚期胎兒靜脈導管血流量與臍靜脈血流量比及臍靜脈肝內(nèi)灌注量與臍靜脈血流量比均值進行t檢驗，差異無統(tǒng)計學意義（P>0.05）。結(jié)論 妊娠中晚期胎兒臍靜脈及靜脈導管血流速度、灌注量隨著孕齡的增大而增加。對應臍靜脈肝內(nèi)灌注血流量也隨孕齡增大而增加，妊娠中晚期分別為57.97%及60.68%，對維持胎兒的發(fā)育生長起優(yōu)先作用。

[關(guān)鍵詞] 靜脈導管；臍靜脈；彩色多普勒；血流灌注

[中圖分類號] R596.11 [文獻標識碼] A [文章編號] 1674-0742（2015）01（c）-0007-03

[Abstract] Objective To detect the blood flow velocity and blood flow of fetal umbilical vein and venous catheter in the second and third trimester of pregnancy so as to determine the level of growth and development of the fetus supplemented by color Doppler ultrasound. Methods Color Doppler ultrasound was used to detect the general fetal development and the lumen diameter， blood flow velocity and blood flow of fetal umbilical vein and venous catheters of its terminal branches in the 60 normal healthy pregnant women with the gestational age of 17 to 40 weeks undergoing the prenatal examination from October 2013 to October 2014. Results There were significant differences in the mean values of blood flow parameters of fetal umbilical vein and the venous catheter between the second and the third trimester of pregnancy， by t test， P<0.001. The difference in the mean ratio of fetal venous catheter blood flow to fetal umbilical vein blood flow， and that in the mean ratio of intrahepatic umbilical vein perfusion to fetal umbilical vein blood flow between the second and the third trimester of pregnancy were not significant， by t test， P>0.05. Conclusion The blood flow velocity and perfusion of fetal umbilical vein and venous catheters in the second and third trimester of pregnancy increase with the increase of gestational age. The intrahepatic umbilical vein perfusion also rises with the increase of gestational age， which increases by 57.97%， 60.68%， in the second trimester and third trimester of pregnancy， respectively， playing preferential interaction in maintaining the development and growth of the fetus.

[Key words] Venous catheter； Umbilical vein； Color Doppler； Perfusion

臍靜脈攜帶來自胎盤含有80%氧氣和營養(yǎng)物質(zhì)較豐富的血液，經(jīng)胎兒腹前壁進入肝臟[1]。臍靜脈是把富含氧和營養(yǎng)物質(zhì)的血從胎盤運送到胎兒體內(nèi)的唯一通道。來自胎盤的血液進入胎兒體內(nèi)分為3支：1支直接入肝，1支與門靜脈匯合入肝，此2支血液經(jīng)肝靜脈入下腔靜脈，另1經(jīng)靜脈導管直接入下腔靜脈[2]。通過多普勒超聲技術(shù)測量2013年10月—2014年10月在該院就診的孕婦，孕20 ～40周胎兒大約20%～30%臍靜脈血流入靜脈導管[3，4]。臍靜脈70%～80%的血流量灌注到肝臟，為灌注的第一個器官[1]，這表明了胎兒在宮內(nèi)生長發(fā)育肝臟的重要性，現(xiàn)報道如下。

1 資料與方法