胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值

Diagnostic value of fetal heart monitor combined with hemodynamic monitoring of umbilical artery,renal artery and middle cerebral artery for fetal intrauterine distress

目的探讨胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值。方法选择2017年6月至2020年6月于我院产检并分娩的150例孕妇作为研究对象,根据胎儿娩出情况将其分为宫内窘迫组(60例)和对照组(90例)。比较两组的胎心监护情况、新生儿结局及脐动脉、肾动脉、大脑中动脉血流动力学指标;分析胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断效能。结果宫内窘迫组的胎心监护异常率、平均胎心率及羊水污染程度≥Ⅱ级、新生儿Apgar评分≤7分占比高于对照组(P<0.05)。宫内窘迫组的脐动脉、肾动脉收缩期峰值速度/舒张末期速度(S/D)、阻力指数(RI)、搏动指数(PI)高于对照组,大脑中动脉S/D、RI、PI低于对照组(P<0.05)。胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断灵敏度、特异度、准确度、阳性预测值、阴性预测值高于单一监测,误诊率、漏诊率均低于单一监测(P<0.05)。结论胎心监护联合脐动脉、肾动脉、大脑中动脉血流动力学监测对胎儿宫内窘迫的诊断价值更高。

Objective To explore the diagnostic value of fetal heart monitor combined with hemodynamic monitoring of umbilical artery,renal artery and middle cerebral artery for fetal intrauterine distress.Methods A total of 150 pregnant women who were examined and delivered in our hospital from June 2017 to June 2020 were selected as the research objects.According to the delivery of the fetus,the pregnant women were divided into intrauterine distress group(60 cases)and control group(90 cases).The fetal heart monitor,neonatal outcome and hemodynamic indexes of umbilical artery,renal artery and middle cerebral artery were compared between the two groups;the diagnostic efficacy of fetal heart monitor combined with hemodynamic monitoring of umbilical artery,renal artery and middle cerebral artery for fetal intrauterine distress was analyzed.Results The abnormal rate of fetal heart monitor,the average fetal heart rate,the proportions of sheep contaminated water≥gradeⅡand neonatal Apgar score≤7 in the intrauterine distress group were higher than those in the control group(P<0.05).The peak systolic velocityend diastolic velocity(S/D),resistance index(RI)and pulsatility index(PI)of umbilical artery and renal artery in the intrauterine distress group were higher than those in the control group,and the S/D,RI and PI of middle cerebral artery were lower than those in the control group(P<0.05).The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of fetal heart monitor combined with hemodynamic monitoring of umbilical artery,renal artery and middle cerebral artery for fetal intrauterine distress were higher than those of single monitoring,and the misdiagnosis rate and missed diagnosis rate were lower than those of single monitoring(P<0.05).Conclusion The fetal heart monitor combined with hemodynamic monitoring of umbilical artery,renal artery and middle cerebral artery has higher diagnostic value for fetal intrauterine distress.