胎儿电子监护(NST)中VD图形研究的临床意义

Clinical significance of variable deceleration in nonstress test

目的探讨孕足月孕妇胎儿电子监护无应激试验(NST)中造成变异减速(VD)的因素及变异减速对围生儿的影响。方法系统分析4320例孕足月孕妇胎儿电子监护NST图形,其中290例出现VD波形,比较造成不同VD波形的因素及变异减速对围生儿的影响。结果 NST中VD波形的发生率为6.71%,其中单纯VD组中影响因素发生率为56.25%,不典型VD组中影响因素发生率为79.23%,发生率差异有显著统计学意义(χ2=17.62,P<0.01);单纯VD组剖宫产率为18.05%,而不典型VD组剖宫产率为69.23%,剖宫产率差异有显著统计学意义(χ2=73.3,P<0.01)。同时,在不典型VD组中,胎儿窘迫、羊水Ⅱ度以上污染及新生儿窒息发生情况均明显高于单纯VD组。结论胎儿电子监护NST中,VD波形的发生与多种因素有关,以脐带因素最常见。通过对本组资料的分析发现,出现不典型VD波形时容易发生胎儿宫内窘迫,新生儿窒息的发生率较高,对新生儿危害较大;特别是出现LD样图形时,更应及时剖宫产终止妊娠。

Objective To investigate the influential factor and corresponding neonatal outcome of variable deceleration （VD） that exist in fetal heart rate （FHR） pattern of nonstress testing （NST）.Methods A retrospective review of 290 FHR patterns with VD in whole 4320 NST records was performed to compare the incidence of the influential factor and the outcome of neonatus between different VD patterns.Results The incidence of VD was 6.71% in NST.The rate of influential factor appeared in simple VD and atypical VD was 56.25% and 79.23% respectively,the difference has statistical significance （P0.05）.Cesarean section rate was 18.05%,69.23% in cases with simple VD and atypical VD respectively,with statistical differences （P0.01）.The incidence of fetal distress,Ⅱ°polluted amniotic fluid and neonatal asphyxia in cases with atypical VD were significantly higher than in cases with simple VD.Conclusion VD which exist in NST is correlated with many factors,and the total umbilical cord abnormality is most common.Fetal distress induces atypical VD more easier than simple VD.