胎心率短期变异的临床意义及其与围产儿结局的关系

Clinical value of short-term variation of fetal heart rate and its relationship with prenatal outcome

目的探讨胎心率短期变异(short-term variation,STV)的临床意义及其与围产儿结局的关系。方法选择2002年1月至2005年12月在浙江大学医学院附属妇产科医院产科分娩的孕妇338例,常规进行无应力试验和声振刺激试验,并进行 STV 与无应力试验及长期变异之间的相关性分析;其中 STV≤2.9 ms 者8例、3.0～3.9 ms 者90例、4.0～4.9 ms 者90例共188例为研究组,STV≥5.0 ms 者150例作为对照组。结果 STV≤2.9 ms 和 STV 为3.0～3.9 ms 的孕妇不良围产儿结局分别为8/8和54.4%(49/90),羊水过少分别为7/8和52.2%(47/90),脐带异常分别为8/8和53.3%(48/90),明显高于 STV 为4.0～4.9 ms 的32.2%(29/90)、16.7%(15/90)、20.0%(18/90)和对照组的25.3%(38/150)、10.0%(15/150)、11.3%(17/150),分别比较,差异均有统计学意义(P<0.05、P<0.01、P<0.01)。无应力试验和长期变异基线 O 型发生率在 STV≤2.9 ms 者和3.0～3.9 ms 者分别为8/8、88.9%(80/90)、8/8、91.1%(82/90),明显高于 STV 为4.0～4.9 ms 者和对照组的64.4%(58/90)、31.1%(28/90)、66.7%(60/90)和21.3%(32/90),分别比较,差异均有统计学意义(P 值均<0.01)。结论 STV 与声振刺激试验后的无应力试验结果及长期变异有良好的相关性;STV<4.0 ms 与胎儿缺氧等不良围产儿结局有关。

Objective To study the clinical value of short term variation （STV） of fetal heart rate. Methods Three hundred thirty-eight pregnant women who delivered at our hospital during June 2002 and Dec 2005 were studied. All the cases were examined by non-stress test （NST） and vibratory acoustic stimulation test （VAST）. Meanwhile, they were also analyzed by Sonicaid system 8002. One hundred fifty cases with STV≥5.0 ms as control group, and 188 cases with STV 〈 5.0 ms as research group were included and divided into different subgroups. Results The rate of poor prenatal outcome in STV between ≤2. 9 ms and 3.0 -3.9 ms groups （8/8,54. 4% ）were higher than those in STV between 4. 0 -4. 9 ms and control groups （32. 2% ,25. 3% ） （P 〈0. 05）. The rate of abnormal non stress test,VAST and type O of long-term variation （LTV） in STV ≤ 2. 9 ms （ 8/8, 8/8, and 88.9% ） and 3.0 - 3. 9 ms groups （ 8/8, 87. 8%, and 91.1% ） was more than those in STV 4. 0 - 4. 9 ms （ 64. 4%, 61.1%, and 31.1% ） or STV ≥5.0 ms groups （66. 7%, 17. 3%, and 21.3% ; P 〈 0. 01 ）. Conclusions These is a good relationship between STV and LTV. These is a better relationship between STV 〈 4. 0 ms and abnormal NST combining with VAST or fetal distress.