产时电子胎心监护减速区面积在新生儿酸中毒预测中的价值

The Predictive Ability of Deceleration Area of Electronic Fetal Monitoring for Neonatal Acidemia at Delivery

目的:探讨产时胎心监护减速区面积在新生儿酸中毒预测中的价值。方法:分析2011年2月至2013年10月在北京大学第三医院住院分娩足月单胎孕产妇204例的分娩前30分钟的胎心监护图形的减速区面积,根据p H<7.20和(或)碱剩余<-12.00 mmol/L分为酸中毒组(26例)和对照组(178例),探讨胎心监护图形的减速区面积与新生儿脐动脉血气的关系,并绘制受试者工作特性曲线(ROC曲线),计算曲线下面积(AUC),预测酸中毒的敏感性和特异性。结果:酸中毒组减速区面积(18.00 cm^2)明显大于对照组(10.50 cm^2),差异有统计学意义(P<0.05)。分娩前30分钟图形的减速区面积的AUC为0.663(95%CI 0.541~0.785),预测酸中毒的敏感性为61.5%,特异性为72.5%。结论:产时胎心监护减速区面积对预测新生儿酸中毒有一定价值,特异性较高,而敏感性欠佳,建议结合更多图形指标解读图形对新生儿酸中毒的预测。

Objective：To explore the predictive ability of deceleration area of electronic fetal monitoring at delivery for neonatal acidemia. Methods：Electronic fetal monitoring（EFM） pattern at 30 minutes preceding delivery and gas analysis results at born from 204 pregnant women in our hospital from February 2011 to October 2013 were recorded. Patients were divided into study group（ pH 〈 7.20 or BE 〈 -12.00 mmol/L） and control group, according to the pH and BE value,to explore the relationship between deceleration area and umbilical cord blood gas. The receiver-operating characteristic curve was drawn according to the information of the 204 cases to get a cut-off value. Results： Deceleration area of study group （18.00cm^2） was larger than that of control group （ 10.50cm^2 ） significantly （ P 〈 0.05）. The AUC （ area under the curve） of deceleration area at 30 minutes preced- ing delivery was 0. 663（95%CI 0. 541 -0. 785）. The sensitivity was 61.5% and the specificity was 72.5%. Conclusions：Deceleration area of EFM is kind of value in predicting neonatal acidemia,with a high specificity and poor sensiticity. It is suggested that combining with other methods to analyze the pattern can be more meaningful.