摘要
目的:探讨超声诊断仪器测量胎儿锁骨长度预测胎儿出生体重的临床价值,对临床研究提供数据参考。
方法:采用临床试验，使用高分辨率四维彩色多谱勒超声诊断仪器（GE Voluson8）。应用四维彩色多普勒超声诊断仪器对孕妇在分娩前0～3天内进行数据测量:(1)记录100例孕妇的年龄、胎儿的孕周，用电子秤记录出生后的新生儿体重数据，使用电子新生儿体重计(误差<10g)，在出生后5min内实施；同时记录出生后的新生儿锁骨长度。(2)把出生后新生儿锁骨长度和出生后的新生儿体重数据用SPSS13.0软件包进行统计学分析，得出两者之间的线性回归方程式。(3)另外我们采集45例孕妇和胎儿测量数据，并验证公式的可行性。胎儿估计体重数据和锁骨长度应用单组重复测量方法，每个数据测三次，取其均值再记录。
结果：1）100例孕37～42周胎儿锁骨平均长度为2.95±0.41cm，范围为2.20～3.80cm。
2）不同出生体重组胎儿锁骨长度总体差异具有统计学意义（F＝10.759,P<0.001）。各组胎儿出生体重得出锁骨长度分别为：胎儿出生体重为2500～g，锁骨长度为2.49±0.25cm；胎儿出生体重为3000～g，锁骨长度为2.87±0.35cm；胎儿出生体重为3500～g，锁骨长度为3.11±0.39cm；胎儿出生体重为4000～g，锁骨长度为3.42±0.16cm。
3）线性回归统计分析结果显示： b＝468.857， P <0.001，直线回归方程为Y2031.696468.857X，公式中Y为胎儿出生体重（g），X为胎儿出生锁骨长度（cm）；胎儿锁骨长度与胎儿体重之间呈正相关（r＝0.568，P <0.001）。
4）45例验证结果中，公式估测胎儿体重符合标准的有32例，占71.1％。
结论：1.新方法测量胎儿锁骨长度预测胎儿体重有可行性。
2.新方法操作简单。
3.对超声医师操作水平和胎儿体位有一定的要求。
Purpose:
To study ultrasound diagnostic instrument measurement fetal collarbone length Predictclinical value of fetal birth weight，Provide reference data for clinical research.
Methods:
The clinical tests, using high resolution four dimensional color spectrum were of diagnosticinstrument (GE Voluson8).Use the color doppler ultrasound diagnostic instrument to pregnantwomen in before childbirth0~3days measurement data:(1) Records of100cases of pregnantwomen age, fetal weeks of gestation, use electronic scales after birth weight newborn record thedata,use electronic accounting weight newborn (error <10g),born in implementation of5min;also recorded after birth of neonatal collarbone length.(2) After the birth of clavicle newbornlength and after birth weight newborn data with SPSS13.0package statistical analysis,concluded between the linear regression equation.(3) In addition we acquisition in45casespregnant women and fetal measurement data,and verify the feasibility of the formula. fetalestimated weight data and the length of clavicle use the repetitive measure method,Each datameasured three times, take the mean to record.
Result:
1)At37to42weeks fetal an average length of clavicle2.95±0.41cm，a range of2.20~3.80cm.
2)Different birth weight group of clavicle length overall difference fetus a statisticallysignificant (F=10.759, P <0.001).The birth weight of clavicle length that are:Fetus birth weightfor2500~g，collarbone length is2.49±0.25cm；fetus birth weight for3000～g，collarbonelength is2.87±0.35cm；fetus birth weight for3500～g，collarbone length is3.11±0.39cm；fetus birth weight for4000～g，collarbone length is3.42±0.16cm.
3) Linear regression statistics analysis shows that: b＝468.857， P <0.001，linear regressionequationY2031.696468.857X，the formulaY for fetus birth weight （g）, X for fetus birthlength of clavicle（cm); fetus birth of clavicle length and fetus birth weight between werepositively correlated （r＝0.568， P <0.001）.
4)45cases in the results of the validation, fetal weight estimation formula standard has32cases, accounting for71.1%.
Conclusion:
1.A new way to measure fetal clavicle prediction feasibility fetal weight length.
2.The new method is easy to operate.
3.Ultrasonic physicians operation level and fetal position has certain requirements.
引文
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[1] B型超声检查估计胎儿体重的研究进展，华绍芳，刘映粦.天津医科大学第一医院产科,300211.
[2]超声测量足月胎儿生长参数预测胎儿体重，张旸，王英华，刘彩娥，张春燕.
[3]张洪洋,刘亚芳,蒋惠竹,等.超声预测胎儿体重方法比较[J].中国妇幼保健杂志,2007(22):3885-3387.
[4]鹿卿,孙颖.超声测量胎儿腹部皮下组织厚度预测胎儿体重的临床观察[J].中国实用妇科与产科杂志,2007[9]:450-451.
[5] Sehild RL,Sachs C, Fimmers R eatl．Sex-specific fetal weight prediction byultrasound．Ultrasound Obstet Gynecol，2004，23：30-35．
[6]产前超声估测胎儿体重研究进展陈萍1，宋月华1，余锦华2，常才3(1．同济大学附属第一妇婴保健院，上海200040；2．复旦大学电子工程系，上海200433；3．复旦大学附属肿瘤医院，上海200032).
[7]超声新技术改革对妇产科临床的影响孙慧琳新疆农八师石河子市计划生育指导中心，新疆石河子832000.
[8] Johnsen SL，Wilsgaard T，Svein Rasmussen S etal．Longitudinal reference charts forgrowth of the fetal head, abdomen and femur．European J Obstet Gynecol and Reprod Biol127(2006)172-185．
[9] Mighzni HM, Weerasinghe S, Ezimokhai Metal．Ultrasonic estimation of fetal weightat term：An evaluation of eight formulae．J Ovstet Gynaecol Res，2005，31(5)：409-413．
[10] Dudley, N. J.: Asystematic review of the ultrasound estimation of fetal weight．Ultrasound Obstet.Gynecol.2004．25：80-89．
[11]妇产科超声新技术的应用和进展(综述)天津市塘沽区妇幼保健院超声中心(300451)张欢，中国医科大学附属第一医院胸外科(110001)赵君.
[12] Patipanawat S, Komwilaisak R, Ratanasiri T．Correlation of weight estimation in largeand small fetuses with three-dimensional ultrasonographic volume measurements of the fetalupper-ann and thigh：A preliminary report．J Med Assoc Thai，2006,89(1):13-19．
[13] Lee W,Deter RL,McNie B,etal．Individualized growth assessment of fetal soft tissueusing fractional thigh volumel．Ultrasound Obstet Gynecol.2004，24(7)：766-774．
[14] Lee W,Deter RL,McNie B,etal.the fetal arm：Individualized growth assessment innormal pregnancies. J Ultrasound Med，2005．24(6)：817-828．
[15] Chang CH，Yu CH，Ko HC，eta1．Predicting fetal growth restriction by humerusvolume：A three-dimensional ultrasound study．Ultrasound Med Biol，2006.32(6)：791-795．
[16] Chang CH，Yu CH，Chang FM，eta1．Volumetric assessment of normal fetal lungsusing three-dimensional ultrasound．Ultrasound in Med Bi0l．2003，29(7)：935—942．
[17] Chang CH，Yu CH，Chang FM，etal．The assessment of normal fetal liver volume bythree dimensional ultrasound．Ultrasound in Medicine and Biology.2003，29(8)：1123-1129．
[18] S．Hassibi，eta1．Optimization of fetal weight estimates using MRI：comparison ofacquisitions．Am．J．Roentgenol，2004，183(2)：487-492．
[19] M.V.Zaretsky，eta1．Comparison of magnetic resonance imaging to ultrasound in theestimation of birth weight at term，Am．J．Obstet．Gynecol，2003，189(4)：1017-1020．
[20] R．A．Kubik-Huch,eta1．Fetus and uteroplacental unit：fast MR imaging withthree-dimensional reconstruction and volumetry-feasibility study.Radiology，2001，219(2)：567-573．
[21] D．Levine．Three-dimensional fetal MR imaging：will it fulfill its promise? Radiology，2001，219(2)：313-315．
[22] J.Uotila eta1.Magnetic resonance imaging compared to ultrasonography in fetal weightand volume estimation in diabetic and normal pregnancy．Acta Obstet. Gynecol. Scand，2000,79(4)：255-259．