孕晚期胎心电子监护出现间歇正弦曲线的临床意义

Clinical significance of intermittent sinusoidal fetal heart rate at third trimester

目的 探讨孕晚期胎心电子监护（CTG）出现间歇正弦曲线的临床意义.方法 对2002年1月至2010年12月在暨南大学第二临床医学院行产前CTG出现正弦曲线的48例孕33～41周孕妇的临床资料进行回顾性分析,其中存在正弦曲线基线特点并持续时间≥10 min不能缓解的21例为持续组,存在正弦曲线基线特点且持续时间＜10 min的27例为间歇组,随机选择同期CTG正常的76例孕妇为对照组.胎头娩出后,取脐动脉血测定血气及血红蛋白水平;新生儿住院期间行常规神经系统检查,确诊新生儿脑损害;比较分析各组新生儿结局的差异.结果 （1）新生儿并发症：间歇组新生儿窒息、羊水Ⅲ度胎粪污染和贫血发生率分别为63%（17/27）、33%（9/27）、63%（17/27）,对照组分别为1%（1/76）、4%（3/76）、3%（2/76）,两组比较,差异均有统计学意义（P＜0.05）;持续组分别为67%（14/21）、52%（11/21）、76%（16/21）,与间歇组比较,差异无统计学意义（P＞0.05）.（2）新生儿血气结果：脐动脉血pH＜7.0的发生率间歇组为18%（5/27）,持续组为52%（11/21）,对照组为0,3组分别比较,差异均有统计学意义（P＜0.05）.（3）新生儿脑损害及死亡：新生儿脑损害发生率和围产儿死亡率间歇组分别为48%（13/27）、11%（3/27）,持续组分别为81%（17/21）、43%（9/21）,对照组均为0,3组分别比较,差异也均有统计学意义（P＜0.05）.结论 孕晚期间歇正弦曲线和持续正弦曲线均是胎儿严重贫血的特征性图形;间歇正弦曲线的发生预示胎儿可能存在比较严重的宫内缺氧.

Objective To investigate clinical significance of intermittent sinusoidal feial heart rate at third trimester.Methods From Jan 2002 to Dec 2010,48 pregnant women at 33 to 41 gestational weeks undergoing electronic fetal heart rate（FHR）monitoring presented with intermittent sinusoidal FHR in Department of Obstetrics and Gynecology,Second School of Clinical Medicine,Jinan University were enrolled in this retrospective study.Twenty-one cases were categorized into continuous group（i.e.with sinusoidal feature and a constant duration≥10 minutes）.while the other 27 cases were categorized iuto intermittent group（i.e.with a duration〈10 minutes）.In the mean time.76 normal cases were chosen randomly matched as control group.Blood gas and hemoglobin were measured in umbilical artery after fetal head delivery.General neurological system examination were performed in those fetus in hospitalization.The outcome of those fetuses was compared.Results （1）Neonatal complications：the rate of asphyxia,meconium-stained amniotic fluid and fetal anemia were 63%（17/27）,33%（9/27）and 63%（17/27）in group of intermittent sinusoidal FHR,which were significantly higher than 1%（1/76）,4%（3/76）,3%（2/76）in control group（P〈0.05）.When compared with 67%（14/21）,52%（11/21）,76%（16/21）in group of continuous sinusoidal,the statistical difierence were not observed（P〉0.05）.（2）Blood gas in neonate：the rates of pH less than 7 were 18%（5/27）in intermittent group,52%（11/21）in continuous group and 0 in control group,which all reached statistical difference among those three groups（P〈0.05）.（3）Brain damage and death：the rates of brain damage and death were 48%（13/27）and 11%（3/27）in intermittent group,81%（17/21）and 43%（9/21）in continuous group,and 0 in control group,which all showed significant difference between them（P〈0.05）.Conclusion Intermittent and continuous sinusoidal FHR are typical graphics of severe fetal anemia at third trimester.Intermittent sinusoidal FHR is indicative of serious fetal hypoxia.