无应激试验和缩宫素激惹试验联合预测胎儿窘迫的临床价值

The clinical value of joint application of non-stress test and oxytocin challenge test in predicting fetal distress

目的探讨无应激试验(NST)和缩宫素激惹(OCT)试验联合胎心监护预测胎儿窘迫的临床价值。方法产前对540例的孕妇行NST+OCT试验,460例行重复NST试验胎心监护预测胎儿窘迫,400例为对照组。产时观察羊水性状及产后新生儿Apgar评分。结果(1)NST+OCT组、重复NST组和对照组胎儿窘迫和新生儿窒息的发生比例,差异无统计学意义(P>0.05);(2)OCT阳性组胎儿窘迫发生比例为59.3%(96/162),新生儿窒息为8.6%(14/162);重复NST异常组胎儿窘迫发生比例为21.7%(93/340),新生儿窒息为2.5%(10/340),OCT阳性组胎儿窘迫和新生儿窒息发生比例高于重复NST异常组,差异有统计学意义(P<0.01);(3)NST+OCT试验预测胎儿窘迫的灵敏度为82.1%(96/117),特异度为84.4%(357/423),符合率为83.9%(453/540);(4)重复NST试验预测胎儿窘迫的灵敏度为87.7%(93/106),特异度为30.2%(107/354),符合率为43.5%(200/460)。结论(1)NST和OCT胎心监护不增加胎儿窘迫和新生儿窒息的发生比例;(2)NST+OCT联合试验用于预测胎儿窘迫比重复NST试验更有应用价值,很大程度上提高了诊断准确率,为积极治疗提供可靠的依据,有助于降低围生儿窒息率及病死率,值得在临床广泛推广应用。

Objective To investigate the clinical value of joint application of non-stress test （NST） and oxytocin challenge test （OCT） in predicting fetal distress. Methods NST group consisted of 540 pregnant women, repeated OCT group 460 pregnant women, and the comparison group 400 pregnant women. Observed characteristics of amniotic fluid and Apgar scores at birth were compared among the three groups. Results Overall there were no differences in the proportions of fetal distress and asphyxia among the three groups. However, OCT group had higher proportions of fetal distress （59. 3 % ） and asphyxia （8.6 % ） when compared with repeated NST group （21.7 % and 2.5 %, respectively）. Sensitivity of the parallel applica- tion of NST and OCT was 82. 1% and specificity 84.4 %, and diagnose accordance rate 83.9 %. The corresponding figures for repeated NST were ： sensitivity, 87.7 %, specificity, 30. 2 %, and accordance rate, 43.5 %. Conclusion No elevation in the proportions of fetal distress and asphyxia was noted in NST and OCT groups. Joint application of NST and OCT was better than repeated NST in predicting fetal distress.