产时胎心短间隔反复性减速与新生儿酸中毒的相关性  

Repetitive variable deceleration with a short interval in labor and neonatal acidosis

作　　者：陈练[1] 王妍[1] 赵扬玉[1] 李淑芳[1] 原鹏波[1] 倪胜莲[1] 赵艳[1] 

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华围产医学杂志》2015年第9期656-660,共5页Chinese Journal of Perinatal Medicine

基　　金：北京市首都卫生发展科研专项基金（首发2014-3-4095）;卫生部临床重点专科建设项目（64470-14）

摘　　要：目的探讨产时胎心短间隔反复性减速与新生儿酸中毒的相关性。方法研究对象为2011年2月至2013年10月在北京大学第三医院住院分娩的177例足月单胎产妇。分娩前持续行胎心监护并记录。分析产妇及新生儿一般资料，包括妊娠合并症、产程时间、脐带胎盘因素、羊水性状以及新生儿和Apgar评分脐动脉血气结果。分娩前1h内胎心监护20min内出现反复减速（50％以上的宫缩伴减速），且减速之间的间隔（即前一个减速结束至下一个减速开始的时间）≤60s者占50％以上，称为“短间隔反复性减速”。采用独立样本t检验、秩和检验、χ^2检验或Fisher精确概率法进行统计学分析。利用存在短间隔反复性减速患者的信息绘制受试者工作特性曲线。结果177例中，存在短间隔反复性减速24例（13．6％）。将这24例作为研究组，其余153例作为对照组。2组产妇的年龄、分娩孕周、产程时间差异均无统计学意义（P值均〉0．05）。研究组产程中Ⅱ度及以上羊水粪染的比例高于对照组[16．7％（4／24）与5．2％（7／153），χ^2=5．204，P=0．045]。研究组新生儿脐血pH值和碱剩余明显低于对照组[分别为7．20（7．13-7．28）与7．29（7．25～7．33），Z=-4．490；-6．10（-9．62～-4．67）mmol／L与-3．20（-4．90～-1．55）mmol／L，Z=-5．044；P值均〈0．01]，出现新生儿酸中毒的比例高于对照组[50．0％（12／24）与7.8％（12／153），χ^2=31．456，P〈0．01]。2组发生新生儿窒息的比例差异无统计学意义。产时胎心短间隔反复性减速与新生儿酸中毒的受试者工作特性曲线下面积为0.774（95％CI：0．579～0．969）。结论产时胎心短间隔反复性减速提示新生儿酸中毒风险明显增大。Objective To discuss the relationship between repetitive variable deceleration with a short interval （RDSI） in labor and neonatal acidosis. Methods One hundred and seventy-seven electronic fetal heart monitoring （EFM） patterns within one hour preceding delivery in term singleton pregnancies were collected in Peking University Third Hospital between February 2011 to October 2013. Continued EFM were recorded before delivery. Analysis was conducted on general information of both mothers and babies, including pregnant complications, duration of labor, cord and placental factors, nature of amniotic fluid, Apgar score and neonatal cord blood gas. RDSI was defined as that over 50% intervals between two decelerations （the end of the last deceleration to the beginning of the next one） ≤ 60 s which appeared repetitevly in a period of 20 minutes. Independent sample t test, rank sum test, Chi-square test and Fisher＇s exact test were applied for statistics and receiver operating characteristic curve was obtained from the information of those with RDSI. Results Twenty-four of the 177 women with RDSI were assigned to the study group （24 cases, 13.6%） and the rest 153 cases without RDSI to the control group. Background information of women in the two groups was comparable according to the maternal age, gestational weeks at delivery and duration of labor （all P 〉 0.05）. Theoccurrence of meconium stained amniotic fluid in the study group was higher than that of the control group [ 16.7% （4/24） vs 5.2% （7/153）, χ^2=5.204, P=0.045], while the pH and base excess value of the neonatal blood gas in the study group were lower [7.20 （7.13-7.28） vs 7.29 （7.25-7.33）, Z= - 4.490; - 6.10 （ - 4.67 to - 9.62） mmol/L vs - 3.20 （ - 4.90 to - 1.55） mmol/L, Z= - 5.044; P 〈 0.01] resulting a higher rate of neonatal acidosis [50.0% （12/24） vs 7.8% （12/153）, χ^2=31.456, P 〈 0.01 ]. No significant difference was found in the incidence of neonatal asphyxia between the two groups. The area

关 键 词：酸中毒 胎心分娩力描记法 减速 胎儿心脏 心率 胎儿 血气分析 

分 类 号：R722.1[医药卫生—儿科]