活跃期和分娩前胎心监护图形与新生儿预后关系的研究  

Research on the Relationship between the Fetal Heart Rate Tracing Patterns in Active Phase and Last Hour before Delivery and the Neonatal Prognosis

作　　者：翁侨[1] 王志群[1] 戴毅敏[1] 

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,江苏南京210008

出　　处：《中国临床医学》2014年第6期707-710,共4页Chinese Journal of Clinical Medicine

摘　　要：目的：分析活跃期和分娩前1 h的胎心监护图形,探讨产程不同时段的胎心监护图形对于判断新生儿预后的指导意义。方法：选择2014年2月—2014年5月在南京大学医学院附属鼓楼医院经阴道分娩的181例单胎足月初产妇,记录并比较活跃期及分娩前1 h的胎心监护图形;采用ROC曲线分析分娩前1 h胎心监护图形及第二产程时长对于新生儿预后的指导意义。结果：181例的胎心监护图形中,未出现III类图形,分娩前1 h胎心监护的I类图形比例低于活跃期,II类图形比例高于活跃期,特殊减速图形的比例较活跃期增加,差异均有统计学意义（P〈0.05）。新生儿不良预后组与新生儿良好预后组相比,活跃期各类图形的差异无统计学意义（P〉0.05）。分娩前1 h,新生儿不良预后组II类图形时长明显长于新生儿良好预后组,而I类图形时长短于新生儿良好预后组（P〈0.05）;不良预后组中发生回复慢、非中度变异减速的比例高于新生儿良好预后组（P〈0.05）。分娩前1 h II类图形时长与新生儿预后关系的受试者工作特征（receiver operating characteristic,ROC）曲线下面积为0.646[95%置信区间（95%CI）：0.544~0.748]。结论：分娩前1 h的胎心监护更容易出现各类减速图形,判读活跃期和分娩前1 h的胎心监护图形可能需要不同的标准。分娩前1 h II类图形时长对判断新生儿预后有一定意义,尤其是出现回复慢、非中度变异减速时。第二产程时长与新生儿预后无明显相关性。Objective：To analyze the fetal heart rate tracing patterns in active phase and last hour before delivery,and to explore the indicative role of fetal heart rate tracing patterns in different labor stages in neonatal prognosis.Methods：A total of181 full-term vaginal delivery primiparas from February 2014 to may 2014 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School.The fetal heart rate tracing patterns in the active phase and those in the last hour before delivery were recorded and compared with each other.Indicative significance of uncertain fetal heart rate tracing patterns duration in the last hour before delivery and long second stage of labor on neonatal prognosis was analyzed with ROC curve.Results：1.No category III fetal heart rate pattern was found in the 181 cases.The proportion of Category I fetal heart rate patterns was lower in the last hour before delivery than that in the active stage while the proportion of category II fetal heart patterns was on the contrary（P〈0.05）.The proportion of atypical decelerations in the last hour before delivery was significantly higher than that in the active stage（P〈0.05）.2.In active stage,no significant difference in any category offetal heart patten was found between the favorable prognosis group and the poor prognosis group（P〉0.05）.3.In the last hour before delivery,duration of category II in the poor prognosis group was longer than that in the favorable prognosis while the duration of category I was on the contrary（P〈0.05）.The proportions of slow returns and non-moderate variability were higher in the poor prognosis group（P〈0.05）.4.The area under the ROC of the relationship between category II duration in the last hour before delivery and neonatal prognosis was 0.646（95%CI 0.544-0.748）.Conclusions：All types of atypical decelerations in fetal heart rate tracing patterns were prone to appear during the last hour before delivery.Different standards may be required to interpret fetal heart rate tracin

关 键 词：胎心监护 三级分类系统 特殊减速 新生儿预后 

分 类 号：R714[医药卫生—妇产科学]