胎心监护对胎儿窘迫诊断的临床评价

摘要

目的 分析产前无应激试验和产时电子胎心监护对胎儿窘迫的诊断价值.方法 采用JpD-300K胎心电子监护仪对五二一医院2010年1月至2011年12月期间住院分娩的2 426例孕妇进行外源性胎心监护,包括无负荷试验(NST)、宫缩负荷试验(CST)和催产素激惹试验(OCT).结果 在701例胎心监护异常者中,423例(60.34%)诊断为胎儿窘迫;1 725例胎心监护正常者中,132例(7.65%)诊断为胎儿窘迫,其胎儿窘迫发生率显著低于胎心监护异常者的发生率(χ2=784.3,P<0.05).胎心监护诊断胎儿窘迫的灵敏度为76.21%,特异度为85.24%,约登指数为0.61.无负荷试验诊断胎儿窘迫的灵敏度为68.54%,特异度为88.15%.宫缩负荷试验诊断胎儿窘迫的灵敏度和特异度分别为88.31%和82.83%;催产素激惹试验诊断胎儿窘迫的灵敏度和特异度分别为80.00%和72.28%.不同监护方法中,宫缩负荷试验的约登指数最大,为0.71.结论 胎心监护对胎儿窘迫诊断的灵敏度和特异度均较高,其中产时宫缩负荷试验诊断价值最高.%Objective To analyze the value of prenatal non-stress test ( NST ) and intrapartum electronic fetal heart rate monitoring for diagnosis of fetal distress. Methods JpD-300K electronic fetal heart monitor was used for 2 426 cases of pregnant women hospitalized for childbirth in National Weapon Industry No. 521 Hospital from January 2010 to December 2011, including NST, contraction stress test ( CST) and oxytocin challenge test ( OCT ). Results Among 701 cases with abnormal fetal heart rate, 423 cases ( 60. 34% ) were diagnosed with fetal distress, while 132 ( 7. 65% ) of 1 725 cases with normal fetal heart rate were diagnosed as fetal distress. The incidence of fetal distress among cases with normal fetal heart rate was significantly lower than that of abnormal fetal heart rate (χ2 = 784. 3 , P<0. 05 ). The sensitivity, specificity and Youden index of fetal heart rate monitoring for diagnosis of fetal distress were 76. 21% , 85. 24% and 0. 61, respectively. The sensitivity and specificity of NST were 68. 54% and 88. 15% , those of CST were 88. 31% and 82. 83% , and those of OCT were 80.00% and 72. 28% , respectively. Of different monitoring methods, Youden index of CST was highest and it was 0.71. Conclusion The sensitivity and specificity of fetal heart rate monitoring for fetal distress diagnosis are relatively high, and CST is most important in intrapartum diagnosis of fetal distress.