【作者】 宋晓平；

【导师】 姚丽艳；

【作者基本信息】 新疆医科大学 ， 外科学， 2009， 硕士

【摘要】 目的：探讨羊膜镜检查、胎心电子监护和B型超声三种检查单独及联合应用监测羊水情况对诊断胎儿窘迫的诊断价值,为临床提供一种诊断胎儿窘迫的可靠方法。方法：于2007年1月-12月对新疆自治区人民医院产科住院分娩符合条件的256例孕妇在剖宫产终止妊娠前—24 h内或临产时均行胎心监护、B超、羊膜镜检查作为筛检方法,将三种检查单独、联合与后羊水情况进行比较,来探讨三种筛检方法在诊断胎儿窘迫的意义。结果：与分娩时羊水情况比较,将B型超声、胎心监护、羊膜镜三者单一检查的敏感度(SEN)、特异度(SPE)、阳性预测值(+PV)、阴性预测值(-PV)、Kappa值、阳性似然比(+LR)、阴性似然比(-LR)分别作对比：B超为72.3214%,34.7222%,46.2857%,61.7284%,0.0663,1.1079,0.7971。胎心监测为76.5766%,43.4483%,50.8982%,70.7865%,0.1891,1.3541,0.5391。羊膜镜为77.8761%,95.8042%,93.6170%,84.5679%,0.750031,18.5605,0.2309。B超、胎心监测联合检查,B超阳性组对羊水情况判断的一致性明显小于胎心监测阳性组(P<0.05)；羊膜镜、B超联合检查,B超阳性组与羊膜镜阳性组对羊水情况的判断具有较好的一致性(P>0.05)；胎心监测、羊膜镜检查联合检查,羊膜镜阳性组对羊水情况判断的一致性明显小于胎心监测阳性组(P<0.05)。结论：羊膜镜检查的敏感度、阳性预测值、Kappa值、阳性似然比明显高于胎心监护、B超,说明羊膜镜的诊断价值较高,而且与分娩时羊水情况比较具有较好的一致性。在B超、胎心监测检查的基础上行羊膜镜联合试验,并联试验、串联试验灵敏度、特异度均增高,说明羊膜镜具有早期诊断价值,联合试验可提高诊断效率。而且说明联合检查能够早期发现胎儿窘迫,是一种行之有效的检查手段,可成为诊断胎儿窘迫的可靠方法,值得推广应用。更多还原

【Abstract】 Objective:To explore the causes of intrauterine fetal distress and to evaluate physiologic and pathological circumstances of intrauterine fetus with amnioscope B-ultrasound、fetal monitor.Methods:In 2007 January-December to Xinjiang autonomous region people hospital obstetrics hospital-lization give birth to baby to match condition of 256 pregnant woman at the Pou temple produce to terminate before the gestation inside the—24 h or about to deliver child all line foetus heart serve as guardian, the B be super, amnion mirror check, will three kinds of check result alone, consociation and empress the amniotic fluid circumstance carry on comparison.Results:With give birth to baby amniotic fluid circumstance comparison, B type super voice, foetus heart serve as guardian, amnion mirror three one check of sensitive degree(SEN), especially difference(SPE),masculine gender estimate value(+PV),feminine gender estimate value(-PV), Kappa value, masculine gender however ratio(+LR), feminine gender however ratio(-LR) set against ratio respectively:B’s ising super is 72.3214%,34.7222%, 46.2857%,61.7284%,0.0663,1.1079,0.7971.The foetus heart monitor is 76.5766%, 43.4483%,50.8982%,70.7865%,0.1891,1.3541,0.5391.The amnion mirror is 77.8761%, 95.8042%,93.6170%,84.5679%,0.750031,18.5605,0.2309.The B is super, foetus heart monitor consociation check form couples data card square examination:have never corrected card square value=10.3333(P<0.05), the amnion mirror, B be super consociation check to form couples data card square examination:have never corrected card square value=10.4386(P<0.05), foetus heart monitor, amnion mirror check consociation check form couples data card square examination:have never corrected card square value=15.7302.(P<0.05) Conclusion:Amnion mirror check of sensitive degree, masculine gender however ratio obvious Gao at the foetus heart serve as guardian, the B be super, elucidation amnion mirror of diagnosis value higher, and with give birth to baby amniotic fluid circumstance comparison have better consistency.Consociation check and one check to diagnosis embryo the hard-pressed difference have statistics to learn meaning, elucidation consociation check is diagnosis the embryo be hardpressed the best check means, can become diagnosis embryo hard-pressed of credibility method.更多还原