Ductus venosus shunting in growth-restricted fetuses and the effect of umbilical circulatory compromise
Ductus venosus shunting in growth-restricted fetuses and the effect of umbilical circulatory compromise
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DOI：
10.1002/uog.2784
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发表时间：
2006-08-01
影响因子：
7.1
通讯作者：
Rasmussen, S.
中科院分区：
文献类型：
--
作者：
Kiserud, T.;Kessler, J.;Rasmussen, S.
目的探讨胎儿宫内生长受限(IUGR)时静脉导管(DV)分流的程度及不同程度脐带循环损害的影响。对64例胎儿宫内发育迟缓(IUGR)胎儿进行了超声检查。测量DV和腹内脐静脉(UV)的内径、血流速度和血流量，计算分流分数和DV/UV管径比值。根据正常脐动脉(UA)搏动指数(PI)、UA-PI和GT；97.5百分位数或无或反向舒张末血流速度(A/REDV)对胎盘损害进行分类。结果生长受限胎儿平均DV分流率为39%，对照组为25%(P<；0.0001)。在UA-PI、UA-PI和GT；97.5百分位数和A/REDV正常的亚组中，相应的值分别为31%、35%和57%。IUGR和UA-PI正常的胎儿(SD评分：平均值，0.48；95%CI，0.04-0.92)与对照组(SD评分：平均值，0.0；95%CI，OAS的-0.15)相比，并不显著增加分流，但UA-PI和GT；97.5百分位数的胎儿(SD分数：平均值，0.8s；95%CI，0.41-1.29)，尤其是A/redv的胎儿(SD分数：平均值，1.56；95%CI，1.0~2.12)分流明显增加。随着DV分流的增多，脐血向肝脏的分布相应减少，其机制之一是DV血流速度降低(P<；0.0001)。结论胎儿DV分流较高，脐血流向肝脏较少，尤其是脐血血流动力学损害最严重的胎儿。版权所有(C)2006 ISUOG。作者：John Wiley&Sons，Ltd.
Objective To determine the degree of ductus venosus (DV) shunting in fetuses with intrauterine growth restriction (IUGR) and the effect of various degrees of umbilical circulatory compromise.Methods This was a cross-sectional observational study. Sixty-four fetuses with IUGR (estimated weight < 2.5(th) percentile) underwent ultrasound examination. The diameter, velocity, and blood flow were determined in the D V and intra-abdominal umbilical vein (UV), and the fraction of shunting and DV: UV diameter ratios were calculated. Placental compromise was classified according to either normal umbilical artery (UA) pulsatility index (PI), UA-PI > 97.5(th) percentile, or absent or reversed end-diastolic flow velocity (A/REDV). Regression analysis was used to construct mean values, and SD scores were used to determine differences compared with a reference population (n = 212) after ln- or power-transformation.Results In the 64 growth-restricted fetuses, the average DV shunting was 39% compared with 25% in the reference group (overall P < 0.0001). The corresponding values in the subgroups with normal UA-PI, UA-PI > 97.5(th) percentile, and A/REDV were 31%, 35%, and 57%, respectively. Fetuses with IUGR and normal UA-PI (SD score: mean, 0.48; 95% CI, 0.04-0.92) did not shunt significantly more than did the reference fetuses (SD score: mean, 0.0; 95% CI, -0.15 to OAS), but those with UA-PI > 97.5(th) percentile (SD score: mean, 0.8S; 95% CI, 0.41-1.29), and particularly those with A/REDV (SD score: mean, 1.56; 95% CI, 1.0-2.12) did shunt significantly more. With more DV shunting, these fetuses distributed correspondingly less umbilical blood to the liver, one of the mechanisms being a lower perfusion pressure as reflected in the lower DV blood velocity (P < 0.0001).Conclusions DV shunting is higher and the umbilical blood flow to the liver is less in fetuses with IUGR, particularly in those with the most severe umbilical hemodynamic compromise. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.