产时胎儿声振刺激试验及其临床意义

Vibratory acoustic stimulation test in labor and its clinical significance

目的 探讨声振刺激试验 (VAST)在产时估价胎儿宫内健康情况的作用。方法 对1296名因宫缩而入院的产妇先行入室试验 (AT)记录20min,继之行VAST后再记录5min。AT被分成3种类型 (反应、可疑、危险 ) ,VAST分阳性或阴性 ,产时观察胎儿有无宫内窘迫 (FD)。结果 在不规则宫缩期AT的阳性预测值为12.9% ,VAST为38.5% ,两者差别有显著性意义 (χ2=4.90,P<0.05) ;潜伏期AT的阳性预测值为14.5% ,VAST为38.1% ,两者差别有显著性意义 (χ2=4.75,P<0.05) ;活跃期AT的阳性预测值为17.2 % ,VAST为22.2% ,两者差别无显著性意义 (χ2=0.27 ,P>0.05) ;宫口近开全至胎儿娩出期 ,AT的阳性预测值为20.7 % ,VAST为17.9% ,两者差别无显著性意义 (χ2=0.08 ,P>0.05)。 结论 在产程早期VAST诊断FD较AT敏感 ,且可缩短试验时间 ,随着产程的进展 ,VAST的敏感性逐渐下降。在产程晚期VAST诊断FD与AT相比无优越性。两者结合可提高对FD的诊断准确率。

Objective To assess the value of vibratory acoustic stimulation test(VAST) in evaluating fetal well-being in labor.Methods Fetal heart rate reaction to VAST were investigated immediately after the admission of 1296 women in labor.All were screened with a 20minute fetal heart rate recording(admission test,AT) before VAST was appiled.Three different types of reponses were observed in AT:reactive,equivocal and ominous.VAST was classitied as positive or negative.The presentation of fetal distress in labor was observed.Results In the irregular uterine contraction period,AT had a positive predictive value of 12.9%,VAST had a positive predictive value of 38.5%.There was significant difference between them(χ 2=4.90,P<0.05);In the latency period,AT was 14.5% and VAST was 38.1%(χ 2=4.74,P<0.05);In the active period,AT was 17.2%,VAST was 22.2%(χ 2=0.27,P>0.05);In the period from cervix dilation to fetus expulsion,AT was 20.7%,VAST was 17.9%(χ 2=0.08,P>0.05).Conclusion In the early period of labor,VAST is more sensitive and needs shorter test time than AT in diagnosing FD.In the later period of labor,VAST does not show more sentitivity than AT,combination of two tests may increase the sensitivity.