非产时完整母胎动态心电图监测对胎儿窘迫的预测价值  

Value of maternal-fetal complete Holter monitoring for predicting fetal distress before delivery

作　　者：张艳[1] 张之霞[1] ZHANG Yan;ZHANG Zhixia(The First People’s Hospital of Xinxiang City,Henan Province,453000)

机构地区：[1]河南省新乡市第一人民医院,453000

出　　处：《中国计划生育学杂志》2020年第10期1591-1595,1723,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨非产时完整母胎动态心电图监测对胎儿窘迫的预测价值。方法:收集2018年1月-2019年10月本院产前检查并住院分娩的孕妇106例临床资料,根据孕妇是否具有高危因素分为高危组(n=50)与低危组(n=56),根据是否为可疑胎儿窘迫分为可疑窘迫组(n=38)与正常组(n=68)。监测并比较各组的非产时Holter参数[胎儿心率基线值(BFHR)、胎儿心率加速次数(LA)、胎儿心率短变异(STV)、胎儿心率低变异周期所占比例(PELV)、胎儿心率高变异周期所占比例(PEHV)、加速力(AC)、减速力(DC)、AC/DC]。结果:高危组与低危组的BFHR、LA、STV、PEHV、AC、DC、AC/DC值比较无差异(P>0.05),PELV高危组高于低危组(P<0.05)。可疑窘迫组与正常组的BFHR、AC、DC、AC/DC值比较无差异(P>0.05);LA、STV、PEHV可疑窘迫组低于正常组,PELV高于正常组(P<0.05)。ROC曲线分析显示,LA(AUC 0.813,95%CI 0.602~0.941)、STV(AUC 0.736,95%CI 0.518~0.893)、PELV(AUC 0.660,95%CI 0.449~0.832)、PEHV(AUC 0.660,95%CI 0.440~0.839),敏感性分别为91.7%、83.3%、84.6%、50.0%,特异性分别为75.0%、58.3%、46.2%、83.3%。Holter参数结合新生儿脐动脉血气指标预测新生儿窒息实际发生有较好的敏感性(78.6%)及特异性(96.2%)。结论:非产时完整母胎Holter监测对胎儿窘迫有一定预测价值,但与高危妊娠不良妊娠结局的关系未明确。Objective: To investigate the value of maternal-fetal complete Holter monitoring for predicting fetal distress before delivery. Methods: From January 2018 to October 2019, 106 pregnant women underwent prenatal examination were selected and were divided into group A 1(50 women with high risk factor) and group A 2(56 women with low risk factor), and also were divided into group B 1(38 women with suspicious fetal distress r) and group B 2(68 normal pregnant women). The Holter parameters before delivery period, such as basal fetal heart rate(BFHR), large acceleration(LA), short-term variation(STV), proportion of episodes of lowvariation(PELV), proportion of episodes of high variation(PEHV), acceleration capacity(AC), deceleration capacity(DC), and AC/DC were monitored and compared among these groups. Results: There were no significant different in the values of BFHR, LA, STV, PEHV, AC, DC, and AC/DC between group A1 and A2(P>0.05), but PELV value of women in group A1 was significant higher than that of women in group A2(P<0.05). There were no significant different in the values of BFHR, AC, DC, and AC/DC between group B1 and B2(P>0.05), and the values of LA, STV, and PEHV of women in group B1 were significant lower than those of women in group B2, but PELV value of women in group B1 was significant higher(P<0.05). The sensibility and specificity of Holter parameter combined with neonatal umbilical arterial blood gas index for predicting the actual occurrence of neonatal asphyxia were 78.57% and 96.15%, respectively. Conclusion: Complete maternal-fetal Holter monitoring before delivery period has certain predictive value for fetal distress, but the relationship between Holter monitoring parameters and adverse pregnancy outcomes of women with high-risk pregnancy is not clear.

关 键 词：胎儿窘迫 母胎动态心电图监测 胎儿心电技术 非产时 高危妊娠 

分 类 号：R714.5[医药卫生—妇产科学]