胎心监护无负荷试验中变异减速的临床分析

Clinical analysis of variable deceleration wave of non-stress test in fetal heart monitoring

目的探讨胎心监护无负荷试验(non-stress test,NST)中重复出现的变异减速(variable deceleration,VD)的影响因素发生率及其结局与处理。方法回顾分析惠州市中心人民医院2003年1月至2008年12月3010例NST中出现VD的216例监护图形,比较不同图形的分娩异常因素及围产儿结局。结果NST中重复出现的VD发生率7.18%(216/3010)。单纯VD中影响因素发生率57.26%(67/117),不典型VD中影响因素发生率95.96%(95/99),差异具有显著意义(P<0.01);在分娩216例新生儿中,1分钟Apgar评分>7分193例,≤7分者23例,其中单纯VD组新生儿窒息率2.56%(3/117),而不典型VD中新生儿窒息率23.23%(23/99),差异具有显著意义(P<0.01);单纯VD组剖宫产率21.37%(25/117)低于不典型VD组58.59%(58/99),差异具有显著意义(P<0.01)。结论NST中重复出现的VD与多种因素有关,脐带因素最常见,不典型VD较典型VD影响因素更明确,新生儿窒息发生率高,VD较典型VD胎儿宫内窘迫发生率高。

Objective To study the influential factors of variable deceleration（VD） in fetal non - stress test （NST） and the newbrn outcome. Methods To analyze the monitoring pattern of 216 case of variable deceleration which occured in 3 010 non-stress tests and compare the incidence of influential factor which caused different pattern and the newborn outcome. Results The incidence of variable deceleration （VD） was 7.18% （216/3010）. The incidence （57.26% ,67/117） of influential factor which caused simple VD signficanfly different from atypical variable deceleration（95.96% ,95/99） （P 〈 0. 01 ）. In the 216 newborns 1 minute Apgar 〉 7 was in 193 case ≤7 in 23 cases. The incidence of neonatal asphyxia in simple VD（2. 56% ,3/117）was significantly less than in atypical VD （21.37% ,23/99） （P 〈0. 01 ）. The incidence of cesarean section in simple VD （21.37% 25/117） was significantly less than that of the atypical VD （58. 59% 58/99） （ P 〈 0. 01 ）. Conclusion The variable deceleration in NST was associated with many factors and umbilical cord abnomality was the most common factor. The atypical VD had a more significant influential factor than simple VD fetal distress occurs in atypical VD more easly than in simple VD.