【摘要】 目的 探讨产科门诊胎心监护无应激试验（NST）与脐血流测定对胎儿窘迫及围生儿结局的判断价值，以降低围生儿不良预后发生率。方法 选择2022年4月至5月福建省妇幼保健院产科门诊收治的2700例孕妇为研究对象。均实施NST、脐动脉（UA）收缩期与舒张期末期血流速比（S/D）测定。根据检测结果进行分组，A组（反应型NST,UA-S/D值<3,n=2310例）、B组（无反应型NST,UA-S/D值<3,n=171例）、C组（反应型NST,UA-S/D值≥3,n=117例）、D组（无反应型NST,UA-S/D值≥3,n=102例）。比较不同检测方法对胎儿窘迫、围生儿不良结局（新生儿窒息、羊水浑浊、围生儿死亡）、剖宫产的预测价值。结果 D组的新生儿Apgar评分中，0～3分与4～7分比例高于其他三组（P <0.05）;D组胎儿窘迫发生率高于A组、B组、C组（P <0.05），且D组胎儿窘迫发生率最高，A组胎儿窘迫发生率最低；D组的新生儿窒息、羊水浑浊、围生儿死亡、剖宫产率高于其他三组（P <0.05）。无反应型NST的新生儿Apgar评分与反应型NST比较，差异有统计学意义（P <0.05）；反应型NST的胎儿窘迫、新生儿窒息、羊水浑浊、围生儿死亡、剖宫产率低于无反应型NST(P <0.05)。UA-S/D值≥3的新生儿Apgar评分与UA-S/D值<3比较，差异有统计学意义（P <0.05）;UA-S/D值<3的胎儿宫内窘迫、新生儿窒息、羊水浑浊、围生儿死亡、剖宫产率低于UA-S/D值≥3 (P <0.05)。结论 实施NST、UA-S/D值检测对胎儿窘迫及围生儿不良预后结局具有显著的预测价值，两种检测方法联合应用，可显著提高胎儿窘迫预测率，及早实施干预措施，以降低围生儿不良结局发生率，更好地保障母婴安全。更多还原

【Abstract】 Objective To explore the value of non-stress test(NST) with fetal heart monitoring and umbilical blood flow measurement in judgment of fetal distress and perinatal outcome in obstetric clinic, in order to reduce the incidence of adverse prognosis of perinatal infants. Methods A total of 2700 pregnant women admitted to the Obstetric Clinic of Maternal and Child Health Care Hospital of Fujian Province from April to May 2022 were selected as the research objects. NST and the ratio of umbilical artery(UA) systolic to end-diastolic blood flow velocity ratio(S/D)were measured. According to the test results, they were divided into group A(reactive NST, UA-S/D ratio <3, n=2310),group B(non-reactive NST, UA-S/D ratio <3, n=171), group C(reactive NST, UA-S/D ratio ≥ 3, n=117) group D(nonreactive NST, UA-S/D ratio ≥ 3, n=102). The predictive value of different detection methods for fetal distress, perinatal adverse outcomes(neonatal asphyxia, amniotic fluid turbidity, perinatal death), and cesarean section rate was compared.Results The proportion of 0-3 and 4-7 points in group D than was higher that in the other three groups in the neonatal Apgar score(P < 0.05). The incidence of fetal distress in group D was higher than that in group A, group B and group C(P < 0.05). The incidence of fetal distress in group D was the highest, while that in group A was the lowest. The rates of neonatal asphyxia, amniotic fluid turbidity, perinatal death and cesarean section in group D were higher than those in the other three groups(P < 0.05). There was statistically significant difference in neonatal Apgar score between non-reactive NST and reactive NST(P < 0.05). The rates of fetal distress, neonatal asphyxia, amniotic fluid turbidity,perinatal death and cesarean section in reactive NST were lower than those in non-reactive NST(P < 0.05). There was statistically significant difference in neonatal Apgar score between UA-S/D ≥ 3 and UA-S/D <3(P < 0.05). The rates of fetal distress, neonatal asphyxia, amniotic fluid turbidity, perinatal death and cesarean section in the UA-S/D <3 were lower than those in the UA-S/D ≥ 3(P < 0.05). Conclusion The detection of NST and UA-S/D values has significant predictive value for fetal distress and adverse outcome of perinatal infants. The combined application of the two detection methods can greatly improve the prediction rate of fetal distress, and implement early intervention measures to reduce the incidence of adverse outcome of perinatal infants, and better ensure the safety of mothers and infants.更多还原