动态监测脐动脉血流及胎心监护在高危孕妇的胎儿窘迫诊断中的应用

目的探讨动态监测胎儿脐动脉血流及胎心监护在高危孕妇胎儿窘迫诊断中的应用价值。方法对2010年1月～2011年12月在我院产科住院的300例高危妊娠孕妇行脐动脉血流s／D值测定及胎心监护监测。并比较分娩后胎儿宫内窘迫发生率、羊水情况、新生儿Apgar评分及脐带绕颈率。结果S／D值≥3、胎心监护异常时，产时（Ⅳ组）在羊水过少发生率（66．7％）、胎儿窘迫发生率（43_3％）、新生儿Apgar评分（48．3％）均明显高于胎心监护及S／D比值正常的孕妇（I组）（47．2％、27_3％、27．3％）。而脐带绕颈在剖宫产发生产时胎儿窘迫也显著高；于胎心监护及S／D比值正常组（I组）（35．0％vs18．2％、66．7％vs44．9％）。Ⅱ组羊水过少发生率（52．0％）、胎儿窘迫发生率（32．O％）、羊水污染发生率（Ⅱ～Ⅲ°）（28．0％）及剖宫产率（60．0％）均高于I组（47．2％、27．3％、18．8％、44．9％），但差异无统计学意义。Ⅱ组脐带绕颈率明显低于I组（4．0％vs18．2％），差异有统计学意义，而Ⅱ组剖宫产率（60．0％）高于Ⅲ组（51．3％），差异无统计学意义。而脐动脉S／D值与胎心监护联合应用在诊断胎儿窘迫的灵敏度、特异度、阳性率与阴性率均较脐动脉S／D值或者胎心监护单独使用有明显升高。结论胎心监护与脐动脉血流S／D值联用能明显提高胎儿窘迫的判断率，对于改善围产儿预后具有积极的临床意义。

Application value of umbilical cord blood flow S/D ratio combined with fetal heart rate monitoring in evaluation of high-risk pregnancy with fetal distress

Objective To investigate the clinical value of umbilical cord blood flow S/D ratio and？fetal heart rate moni- toring in evaluation of high-risk pregnancy women with fetal distress. Methods A total of 300 high-risk pregnancy women were detected by fetal heart rate monitoring and. umbilical artery flow velocimetry from January 2010 to De- cember 2011. The pollution rate of amniotic fluid, the rate of fetal distress and Apgar score of newborn were compared and analyzed. Results The incidence of oligohydramnios（66.7% ）, fetal distress （43.3%）and Apgar score （48.3%）in- creased significantly in IV group than those in normal group （ I group）（47.2% ,27.3% ,27.3%）. The umbilical cord entangle neck of Caesarean section with fetal distress was significantly higher than that in I group （35.0% vs18.2%, 66.7%vs44.9%）. The umbilical cord entangle neck in U group was lower than that in I group （4.0%vs18.2%）with significant difference, and the incidence of caesarean section in 11 group was higher than that in III group （60.0%vs51.3%）,＇ but there was no significant different. The umbilical cord blood flow S/D ratio combined with fetal heart rate monitor- ing in sensitivity, specificity, positive rate, negative rate was better than that of which was single used. Conclusion Detection of S/D ratio of umbilical cord blood flow combined with Fetal heart rate monitoring can obviously increase the judgment and improve the fetal prognosis with fetal distress.