胎心率短变异与基础胎心率的相关性及短时监护分析

The Correlation Analysis between Short Term Variation and Basal Heart Rate and Short Time Monitoring Analysis

目的:胎儿心率监护是围产期的一项重要内容,通过对心率-宫缩曲线(cardiotocogragh,CTG)分析得知胎儿在子宫内是否存在缺氧、窘迫、酸中毒等,以便及时采取相应措施。方法:我们开发了Meticare分析软件包,对采集到的867例CTG数据进行分析计算,探讨了胎心率短变异(STV)与基础胎心率(BHR)之间的关系,并进行基于STV的短时监护分析,利用SAS做了相关回归分析。结果:STV均值与BHR间存在负相关,即STV=9.866-0.02×BHR,且BHR升高,心率曲线波动的幅度(LTV)趋向于减小。5 min及10 min的CTG数据的STV存在高度正相关,即STV10min=2.861-0.596×STV5min。结论:由监护5 min收集到的数据分析计算得出的STV值,对于Dawes&Redman判断标准要求的监护10 min的STV值具有一定的预测意义和参考价值;并且由于STV的计算不需要宫压数据,如果胎心仪集成了STV的计算功能,对于门诊的胎心听诊具有重要意义。妊娠30 W后,随着STV降低,胎儿窘迫、窒息、低体重、甚至死亡率明显递增,而在床边机无分析功能或者用胎心仪听诊的情况下,当BHR升高时,应引起警惕,STV值可能降低,须采取相应措施。

Objective： Fetal monitoring is extremely important in perinatal care. Analysis of cardiotocogragh（CTG） can suppose if the fetus is lack of oxygen, distressed, acidosis, etc. in order to take measures timely. Methods： We have designed Meticare analysis soRware package to analyze 867 pieces of CTG data, and researched the relationship between short term variation （STV） and basal heart rate（BHR） by statistics, and short time monitoring analysis based on STV. Results： The amplitude of fetal heart rate curve variation（long term variation） tended to decrease when BHR increasing, with the negative correlation and regression equation STV = 9.866-0.02×BHR. Positive correlation exists between 5 and 10 minute-STV, with the regression equation STV10min=2.861-0.596×STV5min. Conclusion： STV calculated by 5 minutes CTG data can forecast the one by 10 minutes data as a reference demanded by Dawes ＆ Redman criterion. If fetal doppler contains STV analysis function, out-patient fetal heart auscultation will be more significant. After 30 weeks pregnancy, with the STV decreasing, fetal distress, asphyxia, low birth weight, and even mortality increasing. BHR increasing should cause attention that STV might decrease, when monitoring with no analysis functional devices or fetal dopplars.