胎心监测联合脐血流S/D检测预测胎儿窘迫的价值

Prediction value of fetal distress about the fetal heart monitor with the umbilical blood flow S/D examination

目的探讨胎心监测联合脐血流检测对于胎儿窘迫的预测价值。方法选择2012年1～10月惠州市第一妇幼保健院足月妊娠孕妇690例,按产前胎心监测、脐动脉血流检测结果分为联合组[脐动脉血流S/D值≥2.5,并且无刺激胎心监护(NST)无反应,60例]、脐血流组(单纯进行脐动脉血流检测,并且S/D值≥2.5,280例),以及胎心监测组(单纯进行胎心监测,并且NST无反应,350例)。对三组胎儿窘迫、新生儿不良结局发生率进行观察和比较。结果联合组胎儿窘迫发生率[48.3%(29/60)]高于胎心监测组[27.1%(95/350)]及脐血流组[22.1%(62/280)],差异有统计学意义(P<0.05);胎心监测组与脐血流组胎儿窘迫发生率差异无统计学意义(P>0.05)。联合组羊水污染、新生儿窒息发生率[41.7%(25/60)、5.0%(3/60)]均高于胎心监测组[24.3%(85/350)、0.3%(1/350)]及脐血流组[20.0%(56/280)、0.7%(2/280)],差异均有统计学意义(P<0.05);脐血流组与胎心监测组的羊水污染、新生儿窒息发生率差异无统计学意义(P>0.05)。结论胎心监测联合脐血流S/D值检测能够及早发现和诊断胎儿窘迫,通过及时干预,明显降低新生儿不良结局的发生率,值得临床广泛推广。

Objective To study the prediction value of fetal distress about the fetal heart monitor with the umbilical blood flow S/D examination. Methods 690 pregnant women with full-term pregnancy in the First Maternal and Child Health Hospital of Huizhou City from January to October 2012 were selected and divided into union group （S/D value of umbilical artery blood I〉 2.5, adiaphoria NST, n = 60）, umbilical blood flow group （only the umbilical blood flow examination, and the S/D values〉 2.5, n = 280） and the fetal heart monitor group （only the fetal heart monitor, and adiaphoria NST, n = 350）. The incidence of fetal distress and neonatal adverse outcomes were observed and compared. Results The incidence of fetal distress in union group [48.3% （29/60）] was higher than that in umbilical blood flow group [27.1% （95/350）] and fetal heart monitor group [22.1% （62/280）], the differences were statistically significant （P 〈 0.05）; the difference of incidence of fetal distress in umbilical blood flow group and fetal heart monitor group was not statistically significant （P 〉 0.05）. The incidence of amniotic fluid pollution and neonatal asphyxia in union group [41.7% （25/60）, 5.0% （3/60）] were all higher than those in fetal heart monitor group [24.3% （85/350）, 0.3% （1/350）] and umbilical blood flow group [20.0% （56/280）, 0.7% （2/280）], the differences were statistically significant （P 〈 0.05）; the incidence of amniotic fluid pollution and neonatal asphyxia in fetal heart monitor group and umbilical blood flow group was not statistically significant （P 〉 0.05）. Conclusion The combined examination of the fetal heart monitor and the umbilical blood flow S/D values can early detect and diagnosis the fetal distress, timely give the appropriate treatment, significantly reduce the incidence of adverse neonatal outcomes, and is worthy of wide clinical promotion.