【摘要】 目的研究当CTG正常及出现各种胎儿窘迫波形时脐动脉血流变化情况;分析各组中脐动脉最大最小血流速度之比(S/D)值与胎儿窘迫的关系;评价两种方法联合应用对胎儿窘迫的诊断有何益处。方法选择足月临床孕妇300例,在产时行CTG,其中胎心监护出现异常者,分为晚期减速组(1ate deceleration group,LD组)35例及重度变异减速组(severe variable deceleration group,SVD组)47例,对两组的孕妇分别行产时彩色多普勒脐动脉血流分析,测量其宫缩期及间歇期的最小血流速度(MIN)、最大血流速度(MAX)、S/D、阻力指数(最大最小速度差与最大速度之比,RI),产后观察有无胎儿窘迫,并比较单独使用CTG或S/D值及联合使用两种方法预测胎儿窘迫的敏感性、特异性、阳性预测值,阴性预测值。结果正常组与SVD组、LD组(35例)两组分别比较MIN、S/D和RI之间均有差异;正常组与SVD组、LD组分别比较,SVD组与LD组两组比较,胎儿窘迫的发生率有统计学差异;宫缩间歇期脐动脉S/D值对胎儿窘迫的预测的特异性较高,而其敏感性较低,CTG联合S/D对胎儿窘迫的预测的特异性和敏感性无明显提高;但CTG联合S/D可提高对胎儿窘迫的阳性预测值。结论单纯应用产时脐动脉S/D值筛查胎儿窘迫有较大缺陷,但CTG联合S/D可降低CTG的假阳性,减少不必要的剖宫产,是胎儿窘迫诊断的有益补充。更多还原

【Abstract】 Objective To study the fetal distress waveform happens when normal CTG and umbilical artery blood flow changes:analysis between groups in the ratio of the maximum minimum blood flow velocity(S/D)value and the correlation of fetal distress;Joint application evaluation two methods can improve the diagnosis level of intrapartum fetal distress.Methods Clinical pregnant women,300 cases of full term,in their production with initiative,including cardiac care appear abnormal,divided into late deceleration group(1ate deceleration group,LD group)35cases and severe variation reduction group(severe variable deceleration group,SVD group)and 47 cases,the abnormal cardiac monitoring group and normal control group of pregnant women when the production line of color doppler umbilical artery blood flow analysis,measuring its contractions and break the maximum blood flow velocity(MAX),minimal blood flow velocity(MIN),resistance index(the ratio of the maximum differential minimum speed and maximum speed,RI),S/D,postpartum and observe the presence of fetal distress,and compare the used alone with initiative or S/D value and combination of the two methods to predict fetal distress sensitivity,specificity,positive predictive value,negative predictive value.Results The SVD,LD group and normal group(35cases)in the two groups were compared between MIN,S/D and RI difference;The SVD,LD group and normal group respectively,SVD group compared with LD group two groups,the incidence of fetal distress was statistically difference;Contractions are intermittent period of umbilical artery S/D value of fetal distress prediction specificity,the highest and the lowest sensitivity,CTG joint S/D specificity and sensitivity of fetal distress prediction of improved obviously;But with initiative joint S/D can improve the positive predictive value 94.6%respectively.Conclusion Simple application intrapartum umbilical artery S/D value in the diagnosis of fetal distress have larger defects,but with initiative joint S/D can reduce the false positive of CTG,reduce unnecessary cesarean section,fetal distress diagnosis is a beneficial supplement.更多还原