胎心电子监测分析预测胎儿窘迫的价值

The clinical value of fetal heart electrical monitor in forecasts of fetal distress

目的:评价无应激试验(NST)、缩宫素激惹试验(OCT)、胎儿声振刺激试验(FVAST)、乳头刺激宫缩试验(NS-CST)4种胎心电子监测预测胎儿窘迫的价值。方法:2006年7月～2008年7月,在我院分娩单胎的孕妇2788例,随机分为两组,NST和FVAST组,每组1394例。NST组孕妇先进行NST监测,可疑或无反应型继续进行OCT监测;FVAST组孕妇先进行FVAST监测,可疑或无反应型继续进行NS-CST监测。NST与OCT异常者、FVAST与NS-CST异常者立即剖宫产终止妊娠,结合羊水性状及新生儿Apgar评分,判断产前是否有胎儿窘迫存在,以判断4种监测方法的准确性。结果:NST正常和OCT阴性者、FVAST正常和NS-CST阴性者,围生儿结局较好;NST+OCT异常者和FVAST+NS-CST异常者围生儿胎儿窘迫发生率高,结局较差(P<0.01)。NST+OCT联合监测在预测胎儿窘迫方面正确性优于NST单独监测(P<0.01)。FVAST+NS-CST联合监测亦优于FVAST单独监测,但预测率FVAST高于NST单独监测(P<0.01)。结论:NST、OCT、FVAST、NS-CST均是胎儿监测、预测胎儿窘迫的有效方法;因NS-CST试验不使用药物,NS-CST试验优于OCT试验,FVAST+NS-CST试验优于NST+OCT试验。

Objective：To compare the clinical value of four kinds of fetal heart electrical monitor（FHEM） in forecasts of fetal distress, the FHEM included non-stress test（NST）,oxytocin challenge test（OCT）,fetal vibro-acoustic stimulation test（FVAST） and nipple stimulation constraction stress test（NS-CST）. Methods：2 788 cases of single birth pregnant women were divided into two groups, NST group and FVAST group. FHEM of pregnant women in NST group were monitored with NST first, then those did not respond were monitored with OCT; FHEM of pregnant women in FVAST group were monitored with FVAST first, then those did not respond were monitored with NS-CST. Union the character of amniotic fluid and the Apgar＇s score at birth and to appraises the clinical value of FHRM in forecasting fetal distress. Results：Normal NST and FVAST,negative OCT and NS-CST were sensitive indexes to deplete fetal distress. While union NST＋OCT abnormal and FVAST＋NS-CST abnormal babies had higher fetal distress rates （P〈0.01）. Coincidence, false positive and false negative of union NST＋OCT were better than single NST（P〈0.01）. It was same to union FVAST＋NS-CST and single FVAST（P〈0.01）. Conclusion ：NST, OCT, FVAST and NS-CST are good modus operand to FHEM and forecasts fetal distress. NS-CST is more valuable than OCT,and union FVAST＋NS-CST is more valuable compared with union NST＋OCT,used in forecasting fetal distress.