无负荷试验中变异减速波形的临床意义

目的探讨胎心监护无负荷试验（nonstress test,NST）中变异减速（variable deceleration,VD）发生的影响因素及围生儿结局。方法回顾性分析2160例胎儿监护NST中,141例出现VD患者的胎心心率监护图形,比较不同图形影响因素的发生率和围生儿结局。结果胎心监护NST中,VD的发生率为6.5%（141/2160）。141例出现VD患者中,单纯VD为77例（单纯VD组）,不典型VD为64例（不典型VD组）。单纯VD组中,影响因素发生率为55.84%（43/77）;不典型VD组中,影响因素发生率为95.31%（61/64）,两组比较,差异有显著意义（P〈0.001）。VD患者分娩的141例新生儿中,1min Apgar评分大于7分的为125例,小于7分的为16例。其中,单纯VD组新生儿窒息率为2.59%（2/77）,而不典型VD组新生儿窒息率为21.21%（14/66）,两组比较,差异有显著意义（P〈0.001）。单纯VD组剖宫产率（20.78%）低于不典型VD组（54.69%）,两组比较,差异有显著意义（P〈0.001）。结论胎心监护NST中,VD的发生与多种因素有关,其中脐带异常最常见。胎儿窘迫导致的不典型VD较单纯VD更容易发生。

Clinical significance of variable deceleration in nonstress test

Objective To investigate the influential factor and corresponding neonatal outcome of variable deceleration(VD)that exist in fetal heart rate(FHR)pattern of nonstress testing(NST).MethodsA retrospective review of 141 FHR patterns with VD in whole 2 160 NST records was performed to compare the incidence of the influential factor and the outcome of neonatus between different VD patterns.ResultsThe incidence of VD was 6.5%(141/2 160)in NST.The rate of influential factor appeared in simple VD and atypical VD was 55.84%(43/77)and 92.42%(61/64)respectively,the difference have statistical significance(P<0.001).Among 141 neonatus,125 cases had Apgar scores that higher than 7 at 1 minute,16 cases had that scores lower than 7.Neonatal asphyxia rate was 2.59%(2/77)in cases with simple VD,was 21.21%(14/66)in cases with atypical VD,and the former ones had a lower cesarean section rate than the later ones(20.78% vs.55.05%,P<0.001).ConclusionVD which exist in NST is correlated with many factors,of the total umbilical cord abnormality is most common.Fetal distress induce atypical VD more easier than simple VD.