胎心监护单位时间减速面积与新生儿酸血症的关系
摘要
目的探讨产时胎心监护单位时间减速面积与新生儿酸血症的关系。方法分析2014年11月-2016年8月在民航总医院住院分娩的足月单胎501例孕产妇分娩前20 min胎心监护图形。根据新生儿脐带血血气p H≤7. 10和(或)碱剩余(BE)≤-14 mmol/L分为酸血症组(23例),其余为非酸血症组(478例)。探讨胎心监护单位时间减速面积与新生儿酸血症的关系及预测价值。结果酸血症组单位时间减速面积[5. 36 (3. 16,11. 04) cm2/20 min],显著高于非酸血症组[2. 78 (1. 36,5. 04) cm2/20 min](P<0. 05)。随机抽取70%(350/501)的病例,以单位时间减速面积构建ROC曲线,曲线下面积是0. 657,用约登指数(灵敏度+特异度-1)的最高值作为界限值,验证抽样后剩余30%(151/501)的病例资料。单位时间减速面积按照≥4. 38 cm2/20 min为可疑新生儿酸血症的标准,其判断新生儿酸血症的灵敏度28. 57%,特异度91. 66%,阳性预测值14. 29%,阴性预测值96. 35%,诊断符合率88. 74%。结论胎心监护单位时间减速面积对新生儿酸血症的预测有一定的临床价值。
引文
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[11] Giannubilo SR,Buscicchio P,Gentilucci L,et al. Deceleration area of fetal heart rate trace and fetal acidemia at delivery:a case-control study[J]. J Matern Fetal Neonatal Med,2009,20(2):141-144.
[12] Sheiner E,Hadar A,Hallak M,et al. Clinical significance of fetal heart rate tracings during the second stage of labor[J]. Obstet Gynecol,2001,97(5 Pt 1):747-752.
[13]陈练,赵扬玉,王妍,等.产时胎儿电子监护图的数学特征与新生儿酸中毒的关系[J].中华围产医学杂志,2013,16(11):656-659.
[14]陈练,王妍,赵扬玉,等.产时胎心短间隔反复性减速与新生儿酸中毒的相关性[J].中华围产医学杂志,2015,18(9):656-660.
[15] Yeh P,Emary K,Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome:analysis of 51,519 consecutive validated samples[J]. BJOG,2012,119(7),824-831.
[2]曾丽萍,刘志辉,陈苑红.第二产程胎心监护Ⅱ类图形与新生儿窒息相关性的研究[J].现代妇产科进展,2011,20(6):503-504.
[3] Sholapurkar SL. Computerised interpretation of fetal heart rate patterns and correlation with fetal acidaemia[J]. BJOG, 2014, 121(13):1746-1747.
[4]时青云.产时胎心减速的类型及其处理.中国计划生育和妇产科,2014,6(5):12-16.
[5]李博雅,杨慧霞.产时电子胎心监护规范化临床应用的研究进展.中华妇产科杂志,2014,49(5):385-388.
[6] Novak I. Evidence-based diagnosis,health care,and rehabilitation for children with cerebral palsy[J]. J Child Neurol,2014,29(8):1141-1156.
[7] Andreani M,Locatelli A,Assi F,et al. Predictors of umbilical artery acidosis in preterm delivery[J]. Am J Obstet Gynecol,2007,197(3):303. e1-303. e5.
[8] Roemer VM. How to determine and use base excess(BE)in perinatal medicine[J]. Z Geburtshilfe Neonato,2007,211(6):224-229.
[9]蒋玲玲.活跃期和分娩前胎心监护图形对新生儿预后的临床价值分析[J].中国计划生育学杂志,2015,23(9):630-632.
[10]宋晶,陈奕.胎心电子监护的现状及新技术进展[J].中国妇产科临床杂志,2015,16(5):478-480.
[11] Giannubilo SR,Buscicchio P,Gentilucci L,et al. Deceleration area of fetal heart rate trace and fetal acidemia at delivery:a case-control study[J]. J Matern Fetal Neonatal Med,2009,20(2):141-144.
[12] Sheiner E,Hadar A,Hallak M,et al. Clinical significance of fetal heart rate tracings during the second stage of labor[J]. Obstet Gynecol,2001,97(5 Pt 1):747-752.
[13]陈练,赵扬玉,王妍,等.产时胎儿电子监护图的数学特征与新生儿酸中毒的关系[J].中华围产医学杂志,2013,16(11):656-659.
[14]陈练,王妍,赵扬玉,等.产时胎心短间隔反复性减速与新生儿酸中毒的相关性[J].中华围产医学杂志,2015,18(9):656-660.
[15] Yeh P,Emary K,Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome:analysis of 51,519 consecutive validated samples[J]. BJOG,2012,119(7),824-831.