胎心监测联合脐血流S/D值检测评估胎儿状况的研究

摘要

Objective To discuss the clinical value of fetal heart rate monitoring combined with the ratio of the maximum in the end of systolic phase to that in end of diastolic phase(S/D value)of the umbilical cord blood flow velocities in evaluating fetal status. Methods A total of 150 high risk pregnant women admitted to the First People's Hospital of Xiaoshan District of Hangzhou City were selected and were divided into four groups,the normal group(50 cases),abnormal S/D value group(37 cases),abnormal fetal heart group(21 cases)and double abnormal group(42 cases)according to the results of fetal heart rate monitoring and umbilical cord blood flow S/D value.Fetal heart rate was monitored,cord blood flow S/D value was detected,and neonatal Apgar score was assessed.And the umbilical cord,delivery mode,amniotic fluid and placental abruption of neonates were observed. Results The incidence of oligohydramnios,amniotic fluid contamination,umbilical cord around the neck,fetal distress and cesarean section in the double abnormal group were significantly higher than those in the normal group,abnormal S/D group and abnormal fetal heart group,and the differences were statistically significant(χ2value ranged 4.15-22.75,all P<0.05).The Apgar scores of all 50 neonates in the normal group were 8 -10,accounting for 100.00%,which were significantly higher than those in the abnormal S/D group,the abnormal fetal heart group and the double abnormal group,and the differences were statistically significant(χ2value was 7.17,7.46 and 10.43,respectively,all P<0.05).In the double abnormal group,Apgar scores of 80.95%of cases were between 8-10 scores.Compared with those in abnormal group and abnormal fetal heart group,the differences were not statistically significant(χ2value was 3.09 and 2.15,respectively,both P>0.05).The positive rate of predicting poor prognosis with fetal heart rate monitoring combined with umbilical blood flow S/D was 71.43%,which was significantly higher than the prediction rate of single fetal heart rate monitoring or single umbilical blood flow S/D detection(50.79% and 45.57%),and the differences were significant(χ2value was 4.44 and 7.40,respectively,both P< 0.05).Conclusion Fetal heart rate monitoring combined with umbilical blood flow S/D detecting can predict fetal abnormalities effectively.%目的 探讨胎心监测联合脐血流收缩期末/舒张期末的最大血流速度比值(S/D值)评估胎儿状况的临床价值.方法 选取2014年9月至2016年2月杭州市萧山区第一人民医院收治的150例高危妊娠孕妇,根据胎心监测和脐血流S/D值检测结果将孕妇分为四组:正常组(50例)、S/D值异常组(37例)、胎心异常组(21例)和双异常组(42例),进行孕妇胎心监测和脐血流S/D值检测以及进行新生儿Apgar评分,同时观察新生儿脐带情况、分娩方式、羊水性状以及胎盘早剥程度.结果 双异常组孕妇羊水过少、羊水污染、脐带绕颈、胎儿窘迫和剖宫产的发生率均显著高于正常组、S/D值异常组和胎心异常组,差异有统计学意义(χ2=4.15~22.75,均 P<0.05).正常组50例新生儿Apgar评分均为8~10分,占比100.00%,显著高于S/D值异常组、胎心异常组和双异常组,差异有统计学意义(χ2值分别为7.17、7.46、10.43,均 P<0.05);双异常组新生儿Apgar评分在8~10分占比为80.95%,与S/D值异常组、胎心异常组比较差异无统计学意义(χ2值分别为3.09、2.15,均 P>0.05).胎心监护与脐血流S/D联合预测新生儿预后不良阳性率为71.43%,显著高于胎心监护和脐血流S/D的单独预测率(50.79% 和45.57%),差异有统计学意义(χ2值分别为4.44、7.40,均 P<0.05).结论 胎心监测与脐血流S/D检测可有效预测胎儿异常状况.