胎心监护联合脐血血气分析及Apgar评分预测羊水粪染新生儿窒息的临床价值

Predictive value of fetal heart rate monitoring combined with umbilical arterial blood gas analysis and Apgar score for asphyxia neonatorum with meconium-stained amniotic fluid

目的探讨胎心监护联合脐动脉血气分析及Apgar评分对羊水粪染窒息新生儿的预测价值。方法对585例羊水粪染新生儿进行分娩前胎心监护,出生后立即采集脐动脉血进行p H值测定,进行Apgar评分,分析3项指标与脏器损伤的关系,以及三者联合诊断羊水粪染新生儿窒息的灵敏度、特异度及符合率。结果 585例羊水粪染新生儿中共确诊窒息49例,占8.4%。随着p H值、Apgar评分的降低出现脏器损伤的新生儿比例升高(P<0.05),胎心监护异常组的脏器损伤发生率较正常组明显升高(P<0.05)。低Apgar评分(≤7分)联合异常胎心监护、脐动脉血p H值<7诊断羊水粪染新生儿窒息的敏感性为44.9%,特异性为100.0%,符合率为57.1%;低Apgar评分联合脐动脉血p H值<7.2、异常胎心监护诊断窒息的敏感性为83.7%,特异性为78.6%,符合率为82.5%。结论胎心监护联合脐动脉血气分析、Apgar评分可有效地预测评价羊水粪染新生儿窒息,为窒息新生儿及时采取正确的治疗措施提供了可靠的依据。

Objective To explore the predictive value of fetal heart rate monitoring combined with umbilical arterial blood gas analysis and Apgar score for asphyxia neonatorum with meconium-stained amniotic fluid. Methods A total of 585 neonates with meconium-stained amniotie fluid received the antepartum fetal heart rate monitoring. And the umbilical arterial blood was collected to detect the pH values ,and Apgar score was performed at birth in all neonates. The relationship of the three indices with organ injuries was analyzed. And the sensitivity, specificity and coincidence rate of the three indices were assessed for the combined diagnosis of asphyxia neonatorum with meconium-stained amniotic fluid. Results Of 585 neonates with meconium-stained anmiotic fluid, 49 were definitely diagnosed as asphyxia, accounting for 8.4%. The proportion of neonates with organ injuries increased with the decrease of pH values or Apgar score（P 〈0.05 ）. The incidence of organ injuries in the abnormal fetal heart rate monitoring group was significantly higher than that in the normal group （P 〈 0.05 ）. For diagnosis of asphyxia neonatorum with meeonium-stained amniotic fluid, the sensitivity, specificity and coincidence rate of low Apgar score （≤7） combined with abnormal fetal heart rate monitoring and umbilical arterial pH 〈 7 were 44.9%, 100. 0% and 57. 1% ,respectively;The sensitivity, specificity and coincidence rate of low Apgar score combined with abnormal fetal heart rate monitoring and umbilical arterial pH 〈7.2 were 83.7% ,78.6% and 82.5% ,respectively. Conclusion Fetal heart rate monitoring combined with umbilical arterial blood gas analysis and Apgar score can effectively predict asphyxia neonatorum with meconium-stained amniotie fluid. And it can provide a reliable basis for the early diagnosis and proper treatment of asphyxia neonatorum.