多种胎儿宫内监测方法预测子痫前期新生儿不良结局的比较研究  

Fetal intrauterine monitoring methods for predicting adverse outcomes of neonates with preeclampsia:a comparative study

作　　者：王雅丽 张丽娜[1] 吴青青[1] WANG Yali;ZHANG Li’na;WU Qingqing(Department of Ultrasound,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院超声科,北京市100026

出　　处：《临床超声医学杂志》2021年第4期261-265,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的比较脐动脉监测、胎心监护和胎儿生物物理行为在子痫前期胎儿监测中的应用价值,探讨子痫前期新生儿不良结局的预测指标。方法收集分娩前1周内行脐动脉监测、胎心监护、超声生物物理评分、生物物理评分和改良生物物理评分(MBPP)检查的123例子痫前期单胎孕妇及其新生儿结局资料,对上述监测结果进行分组并比较,应用Logistic回归分析预测新生儿不良结局的相关指标。结果与脐动脉正常组比较,脐动脉舒张末期血流缺失或反向(UA-AREDV)组新生儿不良结局发生率增高(P<0.01);与胎心监护正常组比较,异常NST(或Ⅲ类图形)组新生儿不良结局发生率增高(P<0.01);与MBPP正常组比较,MBPP异常组新生儿不良结局发生率增高(P<0.05)。Logistic回归分析显示UA-AREDV和异常NST(或Ⅲ类图形)预测子痫前期新生儿不良结局的诊断比值比、阳性预测值、阴性预测值比分别为18.4、82.1%、81.0%和5.9、72.2%、73.3%。结论子痫前期胎儿宫内监测指标较多,其中脐动脉监测、胎心监护和MBPP更有优势,UA-AREDV和异常NST(或Ⅲ类图形)对新生儿不良结局具有较好的预测价值。Objective To compare the application value of umbilical artery monitoring,electronic fetal monitoring and fetal biophysical behaviors in the neonate with preeclampsia,and to explore the predictors of adverse outcomes.Methods A total of 123 singleton pregnant women with preeclampsia who underwent umbilical artery electronic fetal monitoring,ultrasonographic biophysical profile,biophysical profile,modified biophysical profile(MBPP)were selected.The results of the five kinds of monitor methods within one week before delivery and neonatal outcomes were recorded.The data of each monitor methods were grouped and compared,the predictive factors of adverse outcomes were analyzed by Logistic regression.Results The incidence of adverse neonatal outcomes was higher in the group with absent or reversed end diastolic velocity of the umbilical artery(UA-AREDV)compared with the normal umbilical artery group(P<0.01).The incidence of adverse neonatal outcomes was higher in the group with abnormal NST(or typeⅢfigure)compared with the normal electronic fetal monitoring group(P<0.01).The incidence of adverse neonatal outcomes was higher in the group with abnormal MBPP scores compared with the normal MBPP scores group(P<0.05).The diagnostic odds ratios of UA-AREDV and abnormal NST(or typeⅢfigure)were 18.4 and 5.9 in predicting adverse neonatal outcomes of patients with preeclampsia.The positive predictive value and negative predictive value of UA-AREDV were 82.1%and 81%,the positive predictive value and negative predictive value of abnormal NST(or typeⅢfigure)were 72.2%and 73.3%in the diagnosis of adverse neonatal outcomes.Conclusion There are many indexes of fetal intrauterine monitor in the pregnant women with preeclampsia.Umbilical artery monitoring,electronic fetal monitoring and MBPP have the advantage of predicting neonatal adverse outcomes.UA-AREDV and abnormal NST(or typeⅢfigure)are valuable in predicting neonatal adverse outcomes.

关 键 词：超声检查 脐动脉监测 胎心监护 改良生物物理评分 子痫前期 新生儿不良结局 

分 类 号：R445.1[医药卫生—影像医学与核医学]