[摘要] 目的 探討超聲測(cè)量胎兒半肩徑的方法及臨床應(yīng)用價(jià)值。 方法 對(duì)我院559例單胎孕37～41周的孕婦進(jìn)行超聲檢查，測(cè)量胎兒半肩徑、雙頂徑、頭圍、腹圍、股骨長(zhǎng)，計(jì)算半肩徑與雙頂徑及半肩徑與腹圍的比值，與出生體重相比較，分析胎兒半肩徑與胎兒難產(chǎn)的關(guān)系，意圖找出胎兒半肩徑的測(cè)量對(duì)難產(chǎn)的評(píng)估價(jià)值。 結(jié)果 巨大兒組半肩徑、雙頂徑、頭圍、腹圍、股骨長(zhǎng)出生體重和半肩徑/雙頂徑大于正常兒組，差異有統(tǒng)計(jì)學(xué)意義（P<0.01）；肩難產(chǎn)組雙頂徑、頭圍、腹圍、半肩、出生體重、半肩徑/雙頂徑、半肩徑/腹圍大于正常組，差異有統(tǒng)計(jì)學(xué)意義（P<0.01）；胎兒半肩徑與出生體重呈正相關(guān)關(guān)系（r=0.722，P<0.01）。 結(jié)論 胎兒半肩徑與肩難產(chǎn)之間呈正相關(guān)關(guān)系，超聲測(cè)量胎兒半肩徑對(duì)預(yù)警胎兒肩難產(chǎn)具有一定的意義。
　　[關(guān)鍵詞] 半肩徑；彩色多普勒超聲；肩難產(chǎn)；半肩徑/雙頂徑
　　[中圖分類號(hào)] R651.3 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2018）08-0053-03
　　Effectiveness of applying ultrasound test of fetal half shoulder diameter on dystocia
　　WANG Jianchun LAN Qiuju ZHANG Dongfang YANG Sufen WANG Qian
　　Chengde Maternity & Child Healthcare Hospital in Hebei Province， Chengde 067000， China
　　[Abstract] Objective To investigate the measure method of fetal half shoulder diameter using ultrasound test and its clinical value. Methods 559 pregnant women in our hospital who were singleton pregnancy and the gestational age was between 37 and 41 weeks were assessed by ultrasound test. Half shoulder diameter， biparietal diameter （BPD），head circumference， abdomen circumference and femur length of fetus were measured. The ratio of half shoulder diameter and BPD and the ratio of half shoulder diameter and abdomen circumference were calculated and compared with birth weight to analyze the relationship between half shoulder diameter of fetus and dystocia and to find out the value of fetus half shoulder diameter measurement on dystocia prediction. Results Half shoulder diameter， BPD， head circumference， abdomen circumference， femur length， birth weight and half shoulder diameter/BPD ratio in fetal macrosomia group were significantly bigger than those in normal group（P<0.01）. BPD， head circumference， abdomen circumference， half shoulder， birth weight， half shoulder diameter/BPD ratio and half shoulder diameter /abdomen circumference ratio in shoulder dystocia group were significantly bigger than those in normal group（P<0.01）. Fetal half shoulder diameter was positively associated with birth weight（r=0.772，P<0.01）. Conclusion Fetal half shoulder diameter was positively associated with shoulder dystocia. Assessment of fetal half shoulder diameter by using ultrasound test could be helpful to alarm fetal shoulder dystocia.
　　[Key words] Half shoulder diameter； Color doppler ultrasound； Shoulder dystocia； Half shoulder diameter/biparietal diameter
　　肩難產(chǎn)是一種高危的產(chǎn)科急癥，全球發(fā)生率為0.58%～2.40%，因其具有不可預(yù)見(jiàn)性而成為產(chǎn)科醫(yī)師極為關(guān)注的重要問(wèn)題[1]。胎頭娩出后，胎兒前肩被嵌頓在恥骨聯(lián)合上方，用常規(guī)助產(chǎn)方法不能娩出胎兒雙肩，稱為肩難產(chǎn)[2]。以胎頭胎體娩出時(shí)間間隔定義肩難產(chǎn)證據(jù)不足。其發(fā)生率因胎兒體重而異，胎兒體重2500～4000 g時(shí)發(fā)生率為0.3%～1.0%，4000～4500 g時(shí)發(fā)生率為3%～12%，≥4500 g為8.4%～14.6%[3-5]。超過(guò)50%的肩難產(chǎn)發(fā)生于正常體重的新生兒，且事先無(wú)法預(yù)測(cè)[6]。本項(xiàng)研究旨在通過(guò)測(cè)量胎兒半肩徑，計(jì)算胎兒半肩徑與雙頂徑的比值以及計(jì)算胎兒半肩徑與腹圍的比值，作為預(yù)測(cè)肩難產(chǎn)發(fā)生風(fēng)險(xiǎn)的胎兒超聲指標(biāo)，能夠給臨床提出指導(dǎo)性建議，以期早期預(yù)測(cè)肩難產(chǎn)，增加臨床預(yù)判能力，現(xiàn)報(bào)道如下。

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