[摘要] 目的 探討超聲測量胎兒半肩徑的方法及臨床應用價值。 方法 對我院559例單胎孕37～41周的孕婦進行超聲檢查，測量胎兒半肩徑、雙頂徑、頭圍、腹圍、股骨長，計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的關系，意圖找出胎兒半肩徑的測量對難產的評估價值。 結果 巨大兒組半肩徑、雙頂徑、頭圍、腹圍、股骨長出生體重和半肩徑/雙頂徑大于正常兒組，差異有統計學意義（P<0.01）；肩難產組雙頂徑、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，差異有統計學意義（P<0.01）；胎兒半肩徑與出生體重呈正相關關系（r=0.722，P<0.01）。 結論 胎兒半肩徑與肩難產之間呈正相關關系，超聲測量胎兒半肩徑對預警胎兒肩難產具有一定的意義。
　　[關鍵詞] 半肩徑；彩色多普勒超聲；肩難產；半肩徑/雙頂徑
　　[中圖分類號] R651.3 [文獻標識碼] B [文章編號] 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
　　肩難產是一種高危的產科急癥，全球發(fā)生率為0.58%～2.40%，因其具有不可預見性而成為產科醫(yī)師極為關注的重要問題[1]。胎頭娩出后，胎兒前肩被嵌頓在恥骨聯合上方，用常規(guī)助產方法不能娩出胎兒雙肩，稱為肩難產[2]。以胎頭胎體娩出時間間隔定義肩難產證據不足。其發(fā)生率因胎兒體重而異，胎兒體重2500～4000 g時發(fā)生率為0.3%～1.0%，4000～4500 g時發(fā)生率為3%～12%，≥4500 g為8.4%～14.6%[3-5]。超過50%的肩難產發(fā)生于正常體重的新生兒，且事先無法預測[6]。本項研究旨在通過測量胎兒半肩徑，計算胎兒半肩徑與雙頂徑的比值以及計算胎兒半肩徑與腹圍的比值，作為預測肩難產發(fā)生風險的胎兒超聲指標，能夠給臨床提出指導性建議，以期早期預測肩難產，增加臨床預判能力，現報道如下。

相關熱詞搜索：難產 超聲 胎兒 檢查 研究