产时胎心减速特征对Ⅱ型胎心监护解读意义研究  

Clinical significance of the characteristics of the deceleration of the fetal heart rate in the interpretation of type Ⅱ fetal heart monitoring graphics

作　　者：李娜[1,2] 赵扬玉[1] 王妍[1] 杨悦[2] 陈练[1] 郝静[2] 

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]民航总医院妇产科,北京100123

出　　处：《中国实用妇科与产科杂志》2017年第1期108-113,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市首都医学发展科研基金(A75468-04)

摘　　要：目的探讨产时胎心减速特征对Ⅱ型胎心监护解读的临床意义。方法分析2014年11月至2015年12月在民航总医院住院分娩的足月单胎481例孕产妇分娩前20 min胎心监护图形。根据新生儿脐带血血气pH<7.20和(或)碱剩余(BE)<-12 mmol/L分为酸中毒组(137例),其余为非酸中毒组(344例)。探讨产时胎心减速特征(单位时间减速面积和减速持续时间比例)与新生儿酸中毒的关系及其预测价值。结果酸中毒组单位时间减速面积[6.297(2.78~7.42)m^2/20 min]和减速持续时间比例[(31.64±17.72)%]均显著高于非酸中毒组[2.99(1.12~3.99)m^2/20 min,P<0.001;(20.20±15.17)%,P<0.001]。分娩前20 min图形单位时间减速面积AUC为0.722(95%CI0.661~0.783),预测酸中毒敏感度和特异度分别为71.58%和60.09%。减速持续时间比例AUC为0.678(95%CI0.614~0.742),预测酸中毒的敏感度和特异度分别为72.63%和68.20%。经过验证,这两项胎心监护减速特征对判断酸中毒的敏感度为66.67%和61.90%,特异度为75.00%和65.38%。单位时间减速面积的AUC大于减速持续时间比例的AUC,差异有统计学意义(Z=3.215,P<0.05)。结论产时胎心减速特征(单位时间减速面积和减速持续时间比例)对辅助Ⅱ型胎心监护的解读有一定的临床价值。Objective To explore the clinical significance of the characteristics of fetal heart rate reduction in type Ⅱfetal heart rate monitoring. Methods A total of 481 pregnant women who were hospitalized and delivered in Civil Aviation General Hospital were selected from November 2014 to December 2015.The graphics of fetal heart rate monitoring 20 minutes before birth were analyzed.According to the results of blood gas analysis,PH〈7.20 and（or）BE〈-12.00 mmol/L,137 cases were included in acid poisoning group and 344 cases in non-acidosis group.Investigate the relationship between the characteristics of fetal heart rate reduction（the unit time deceleration area and deceleration duration ratio）and the neonatal acidosis and its predictive value. Results The proportion of the unit time deceleration area[6.297（2.78～7.42）m2/20 min]and deceleration duration ratio[（31.64±17.72）%]in acid poisoning group were significantly higher than those in non-acid poisoning group[2.99（1.12～3.99）m2/20 min,P〈0.001;（20.20±15.17）%,P〈0.001].The difference was statistically significant.The unit time deceleration area AUC at 20 minutes before the birth was 0.722（95% CI：0.661～0.783）and the sensitivity and specificity of acid poisoning were 71.58% and 60.09%,respectively.The deceleration duration ratio AUC was 0.678（95%CI：0.614～0.742）,and the sensitivity and specificity of acid poisoning were 72.63% and 68.20%,respectively.After validation,the sensitivity of the characteristics of the two fetal heart rate monitoring deceleration to acid poisoning was 66.67% and 61.90%,specificity 75% and 65.38%.The AUC size of the unit time deceleration area was greater than that of the deceleration duration ratio,the difference being statistically significant（Z=3.215,P〈0.05）. Conclusion The characteristics of the deceleration of fetal heart rate（unit time deceleration area and deceleration duration ratio）have a certain clinical value in the interpretation of type Ⅱ fetal heart monitoring graphics.

关 键 词：胎心监护 血气分析 酸中毒 减速 

分 类 号：R714[医药卫生—妇产科学]