构建产前胎儿风险预测模型的临床价值
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摘要
目的探讨胎心监护、胎儿脐血流S/D值、羊水指数(AFI)与新生儿1 min Apgar评分的关系,构建产前胎儿风险预测模型。方法选取2018年1月至2018年8月我院收治的915例足月单胎孕妇,分析其临床资料,收集分娩前最后一次检查结果,包括胎心监护、脐血流S/D值、B超测定AFI及新生儿1 min Apgar评分。结果单因素分析结果显示,胎心监护Ⅰ类、脐血流S/D值<3、羊水偏少至正常者的新生儿1 min Apgar评分≤7的发生率明显低于Ⅱ～Ⅲ类、脐血流S/D值≥3、羊水过少者(P<0.05);多因素Logistic回归分析结果显示,胎心监护、脐血流S/D值、AFI均为新生儿1 min Apgar评分≤7分的危险因素(P<0.05)。风险预测模型的AUC=0.844,胎心监护的AUC=0.545,脐血流S/D值的AUC=0.763,AFI的AUC=0.735;风险预测模型的AUC高于各单项检测指标。结论构建产前胎儿风险模型对新生儿1 min Apgar评分的预测价值较高,有利于降低新生儿不良结局的发生率,值得临床应用。
Objective To explore the relationship between fetal heart rate monitoring, fetal umbilical blood flow S/D value, amniotic fluid index(AFI) and neonatal 1 min Apgar score, and to construct a prenatal fetal risk prediction model.Methods A total of 915 full-term single pregnant women admitted in our hospital from January 2018 to August 2018 were selected, their clinical data were analyzed, the results of the last examination before delivery were collected, including fetal heart rate monitoring, umbilical cord blood flow S/D value, AFI measured by B-mode ultrasonography and neonatal 1 min Apgar score. Results The result of univariate analysis showed that the incidences of neonatal 1 min Apgar score ≤7 in typeⅠ of fetal heart monitoring, umbilical blood flow S/D value<3, less to normal amniotic fluid amount were significantly lower than those in type Ⅱ-Ⅲ of fetal heart monitoring, umbilical blood flow S/D value≥3, oligohydramnios(P<0.05); the results of multivariate Logistic regression analysis showed that fetal heart rate monitoring, umbilical blood flow S/D value and AFI were risk factors for neonatal 1 min Apgar score ≤7(P<0.05). AUC of risk prediction model was 0.844, AUC of fetal heart rate monitoring was 0.545, AUC of umbilical cord blood flow S/D value was 0.763, AUC of AFI was 0.735; the AUC of risk prediction model was higher than that of each individual detection index. Conclusion Establishment of prenatal fetal risk model has high predictive value for neonatal 1 min Apgar score, which is conducive to reducing the incidence of adverse neonatal outcomes, and is worthy of clinical application.
Objective To explore the relationship between fetal heart rate monitoring, fetal umbilical blood flow S/D value, amniotic fluid index(AFI) and neonatal 1 min Apgar score, and to construct a prenatal fetal risk prediction model.Methods A total of 915 full-term single pregnant women admitted in our hospital from January 2018 to August 2018 were selected, their clinical data were analyzed, the results of the last examination before delivery were collected, including fetal heart rate monitoring, umbilical cord blood flow S/D value, AFI measured by B-mode ultrasonography and neonatal 1 min Apgar score. Results The result of univariate analysis showed that the incidences of neonatal 1 min Apgar score ≤7 in typeⅠ of fetal heart monitoring, umbilical blood flow S/D value<3, less to normal amniotic fluid amount were significantly lower than those in type Ⅱ-Ⅲ of fetal heart monitoring, umbilical blood flow S/D value≥3, oligohydramnios(P<0.05); the results of multivariate Logistic regression analysis showed that fetal heart rate monitoring, umbilical blood flow S/D value and AFI were risk factors for neonatal 1 min Apgar score ≤7(P<0.05). AUC of risk prediction model was 0.844, AUC of fetal heart rate monitoring was 0.545, AUC of umbilical cord blood flow S/D value was 0.763, AUC of AFI was 0.735; the AUC of risk prediction model was higher than that of each individual detection index. Conclusion Establishment of prenatal fetal risk model has high predictive value for neonatal 1 min Apgar score, which is conducive to reducing the incidence of adverse neonatal outcomes, and is worthy of clinical application.
引文
[1]OTT WJ.Development of a fetal risk assessment score for the prediction of neonatal outcome in the growth-restricted fetus[J].J Matern Fetal Neonatal Med,2012,25(10):1941-1944.
[2]BULLETINS ACOP.ACOG Practice Bulletin.No.62:intrapartum fetal heart rate monitoring[J].Obstet Gynecol,2005,105(1):1161-1169.
[3]易媛媛,周晓霞,福林.脐血流S/D值测定高预测危妊娠孕晚期胎儿窘迫的意义[J].内蒙古医科大学学报,2016,38(6):485-487.
[4]谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018:156-157.
[5]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:183.
[6]刘兴会,彭冰,杨小芸,等.剖宫产指征的变迁分析[J].四川大学学报:医学版,2003,34(1):180-181.
[7]PUERTAS A,NAVARRO M,VELASCO P,et al.Intrapartum fetal pulse oximetry and fetal heart rate decelerations[J].Int J Gynecol Obstet,2004,85(1):12-17.
[8]秦莲芝.胎心监测联合脐血流测定对预测妊娠晚期胎儿健康状况的临床意义[J].山东医学高等专科学校学报,2013,35(3):202-204.
[9]李燕飞,陈晓霞,李尚秀.胎儿脐血流监测及胎心监护监测在高危妊娠中的预测价值[J].广东医学,2014,35(13):2058-2059.
[10]段涛,杨慧霞.高危妊娠[M].北京:人民卫生出版社,2008:206-258.
[11]苏燕.胎心监测与脐血流测定用于妊娠晚期胎儿健康状况预测中的临床效果[J].中国继续医学教育,2016,8(26):107-108.
[12]周丽.妊娠晚期胎心监护与脐血流测定联合应用对胎儿预后的临床意义[J].实用妇科内分泌杂志:电子版,2015,2(2):196-197.
[13]李为莲,蔡艳,吴晓莹.足月妊娠羊水过少孕妇的超声诊断与临床分析[J].现代医用影像学,2017,26(6):1781-1783.
[14]弓瑜,李宏伟.300例足月妊娠孕妇四维超声诊断羊水过少的妊娠结局分析[J].中国当代医药,2013,20(23):103-104.
[15]李莎.超声诊断羊水过少对足月妊娠孕妇妊娠结局影响分析[J].中外医学研究,2014,12(2):52-53.
[16]HOLMGREN CM,ESPLIN MS,JACKSON M,et al.A risk stratification model to predict adverse neonatal outcome in labor[J].J Perinatol,2013,33(12):914.
[2]BULLETINS ACOP.ACOG Practice Bulletin.No.62:intrapartum fetal heart rate monitoring[J].Obstet Gynecol,2005,105(1):1161-1169.
[3]易媛媛,周晓霞,福林.脐血流S/D值测定高预测危妊娠孕晚期胎儿窘迫的意义[J].内蒙古医科大学学报,2016,38(6):485-487.
[4]谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018:156-157.
[5]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:183.
[6]刘兴会,彭冰,杨小芸,等.剖宫产指征的变迁分析[J].四川大学学报:医学版,2003,34(1):180-181.
[7]PUERTAS A,NAVARRO M,VELASCO P,et al.Intrapartum fetal pulse oximetry and fetal heart rate decelerations[J].Int J Gynecol Obstet,2004,85(1):12-17.
[8]秦莲芝.胎心监测联合脐血流测定对预测妊娠晚期胎儿健康状况的临床意义[J].山东医学高等专科学校学报,2013,35(3):202-204.
[9]李燕飞,陈晓霞,李尚秀.胎儿脐血流监测及胎心监护监测在高危妊娠中的预测价值[J].广东医学,2014,35(13):2058-2059.
[10]段涛,杨慧霞.高危妊娠[M].北京:人民卫生出版社,2008:206-258.
[11]苏燕.胎心监测与脐血流测定用于妊娠晚期胎儿健康状况预测中的临床效果[J].中国继续医学教育,2016,8(26):107-108.
[12]周丽.妊娠晚期胎心监护与脐血流测定联合应用对胎儿预后的临床意义[J].实用妇科内分泌杂志:电子版,2015,2(2):196-197.
[13]李为莲,蔡艳,吴晓莹.足月妊娠羊水过少孕妇的超声诊断与临床分析[J].现代医用影像学,2017,26(6):1781-1783.
[14]弓瑜,李宏伟.300例足月妊娠孕妇四维超声诊断羊水过少的妊娠结局分析[J].中国当代医药,2013,20(23):103-104.
[15]李莎.超声诊断羊水过少对足月妊娠孕妇妊娠结局影响分析[J].中外医学研究,2014,12(2):52-53.
[16]HOLMGREN CM,ESPLIN MS,JACKSON M,et al.A risk stratification model to predict adverse neonatal outcome in labor[J].J Perinatol,2013,33(12):914.