三种电子胎心监护评价系统评估新生儿酸中毒的效果比较  

Effectiveness of three electronic fetal monitoring systems in identifying neonatal acidosis during labor

作　　者：仇黎丽[1] 呼慧莲 杨玲[1] 顾宁[1] 朱振华[1] 方婧[1] 周燕 戴毅敏[1] Qiu Lili;Hu Huilian;Yang Ling;Gu Ning;Zhu Zhenhua;Fang Jing;Zhou Yan;Dai Yimin(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210016,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,南京210016

出　　处：《中华围产医学杂志》2024年第5期362-370,共9页Chinese Journal of Perinatal Medicine

摘　　要：目的分析产时电子胎心监护(electronic fetal monitoring,EFM)Parer-五级、美国国家儿童健康与人类发展研究院(National Institute of Child Health and Human Development,NICHD)-三级和国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)-三级评价系统评估新生儿酸中毒的有效性和观察者间一致性。方法回顾性分析2020年1月至2020年12月在南京大学医学院附属鼓楼医院足月单胎头位分娩酸中毒新生儿(脐动脉血pH值≤7.1)和正常新生儿(脐动脉血pH值≥7.2)产妇分娩前1 h内至少30 min的EFM图形资料,对病例的临床特征及母儿结局设盲。4名产科医生分别独立对随机排序并编码的EFM图形进行特征描述。另1名产科医生参照NICHD-、FIGO-三级和Parer-五级评价系统,根据图形特征进行分级评价。分析3种系统评估新生儿酸中毒的灵敏度和特异度,以及观察者间一致性。分别采用独立样本t检验、χ^(2)检验(或Fisher精确概率法)或Mann-Whitney U检验进行统计学分析。3种评价系统组间灵敏度和特异度比较采用McNemar检验。用Kappa检验分析观察者之间的一致性。结果(1)共3558例进入本研究。经倾向性评分匹配后,酸中毒组和对照组分别为44例和78例。2组产妇的产次、分娩孕周、临产方式、胎盘早剥和分娩镇痛率差异均无统计学意义。酸中毒组阴道助产率和新生儿收住重症监护病房率明显高于对照组[15.8%(7/44)与2.6%(2/78),χ^(2)=8.45,P=0.003;31.8%(14/44)与12.8%(10/78),χ^(2)=8.45,P=0.004],脐动脉血pH值和平均碱剩余低于对照组[7.04±0.07与7.30±0.05,t=4.98;(-12.40±3.32)与(-5.64±1.95)mmol/L,t=13.61;P值均<0.001]。(2)在NICHD-三级评价系统中,酸中毒和对照组分别有95.5%(42/44)和89.7%(70/78)为可疑胎儿酸碱失衡的Ⅱ类图形,酸中毒组仅4.5%(2/44)为Ⅲ类图形。在FIGO-三级评价系统中,酸中毒组81.8%(36/44)的图形为“病理图形”;Parer-五级评价系统中提示�Objective To analyze the effectiveness and interobserver agreement of the Parer five-tier,the National Institute of Child Health and Human Development(NICHD)three-tier,and the International Federation of Gynecology and Obstetrics(FIGO)three-tier electronic fetal monitoring(EFM)systems in identification of neonatal acidosis during labor.Methods This retrospective study was conducted on full-term singleton cephalic deliveries with neonatal acidosis(umbilical artery blood gas pH≤7.1)and normal newborns(umbilical artery blood gas pH≥7.2)in the Nanjing Drum Tower Hospital,Nanjing University Medical School from January to December 2020.EFM tracings during the last 30-60 min before delivery were collected.Four obstetricians independently described the features of randomly sorted and coded EFM tracings.Another obstetrician categorized these tracings using the NICHD three-tier,FIGO three-tier,and Parer five-tier evaluation systems based on the features.All researchers were masked to the clinical characteristics and maternal and neonatal outcomes.The sensitivity and specificity for identifying neonatal acidosis,as well as the interobserver agreement,were analyzed for all three systems.Independent sample t-test,Chi-square(or Fisher's exact test)and Mann-Whitney U tests were used for statistical analysis.Inter-group comparisons of sensitivity and specificity between the three evaluation systems were assessed using McNemar's test.The Kappa statistic was used to analyze interobserver agreement.Results This study included a total of 3558 cases.After propensity score matching,there were 44 cases of neonatal acidosis and 78 control cases.There were no significant differences in parity,gestational weeks,modes of delivery,placental abruption,or analgesia rates between the two groups.The rates of instrumental vaginal delivery and neonatal intensive care unit(NICU)admission in the acidosis group were significantly higher than those in the control group[15.8%(7/44)vs.2.6%(2/78),χ^(2)=8.45,P=0.003;31.8%(14/44)vs.12.8%(10/78),χ^(2

关 键 词：胎儿监测 酸中毒 胎儿缺氧 电子胎心监护 病例对照研究 

分 类 号：R722.1[医药卫生—儿科]