产前无应激试验低评分的相关因素及围产结局(1)
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【摘要】 目的 探讨无应激试验低评分的相关因素及临床意义，寻求最佳分娩方式。方法 用电子胎儿监护仪对1431例孕妇进行无应激试验(NST)，对其中129例NST≤9分者按正常妊娠和高危妊娠分两组进行分析。结果 高危妊娠组胎心基线率变异消失或减弱为74.3%，剖宫产率占91.4%，羊水粪染率占71.4%，新生儿窒息率占28.6%，有2例围产儿死亡；正常妊娠组相对应数据分别为24.5%、55.3%、19.1%、2.1%，无围产儿死亡病例。两组比较差异有显著性(P<0.01)。分析两组相关因素，高危妊娠组中羊水过少，妊娠期肝内胆汁淤积症、妊娠期高血压疾病及胎儿生长受限等病症占有一定比例；而正常妊娠组产后发现明显原因致NST低评分系脐带因素的有28例(29.8%)，无明显原因者占67.0%。结论 高危妊娠NST低评分者应引起高度重视，适时终止妊娠，降低围产儿病死率；正常妊娠NST低评分者可行OCT、生物物理评分等进一步监测，选择适当分娩方式。
【关键词】胎儿监测；产前诊断；妊娠，高危；分娩
The related factors and perinatal outcomes of the low scores about prenatal nonstress test
PENG Ke.Departmet of cynecol & Obstet,Central hospital of Huizhou,Guangdong 516000，China
【Abstract】 Objective To study related factors and clinical meaning of the low scores about nonstress test,and find out the best childbearing mode.Methods 1431 cases of pregnant women were tested with nonstress test(NST).129 cases with NST≤9 scores in 1431 cases were divided into two groups between normal pregnancy group and high risk pregnancy group.Results Rate of reduction or disappearance of baseline variability in high risk pregnancy group was 74.3%,caesearean section was 91.4%,meconium stained amniotic fluid was 71.4%,and asphyxia neonatorum was 28.6%and there were 2 perinatal newborns dead;But the date of normal pregnancy group was 24.5%,55.3%,19.1%,and 2.1%respectively.There were no perinatal newborns dead in this group(P<0.01).Analyzing related factors,oligohydramnios,ICP,HDCP and FGR were major ones in high risk pregnancy group.In contrast,umbilical factors which gave rise to low scores after parturition in the normal pregnancy group were 28 cases(29.8%)while no obvious factors were 67.0%.Conclusion More attention should be paid to high risk pregnancies which were low scores,and pregnancy should be terminated promptly in order to lower perinatal mortality;The pregnant women in normal pregnancies should be tested with OCT,BPS and so on.It should choose appropriate childbearing method to further monitor.
【Key words】Fetal monitoring;Prenatal diagnosis;Pregnancy,high-risk;Parturition
围生期监护是降低孕产妇和围生儿病死率的关键。如何做好对围生期的母儿监测，方法很多，其中无应激试验(NST)对协助临床诊断胎儿宫内是否缺氧起到重要作用，尤其是对高危妊娠者如何选择分娩方式及分娩时间有一定的指导意义。笔者对本院>35孕周的1431例孕妇行NST监测，对评分≤9分者进行临床分析。
1 材料与方法
1.1 材料来源 2004-2005年广东省惠州市中心人民医院住院产妇1431例，年龄22~36岁，孕周35+4~41+6周，均为单胎。入院后常规行NST监测，收集NST≤9分者的资料，将整个孕期无妊娠合并症、并发症的孕妇94例为正常妊娠组，有危及孕妇和胎儿健康疾病的孕妇35例为高危妊娠组，两组对照进行分析。两组孕产妇在孕周、身高、年龄、新生儿体质量等方面经统计学分析差异无显著性(P>0.05)。
1.2 方法 选用飞利浦公司生产的M138lD型中央监护系统及胎儿监护仪，由专人操作。监护时孕妇取15°半卧位或左侧卧位，连续监护30 min。无胎动者，轻推腹部，刺激胎儿，再延长20 min。
1.3 判断标准
1.3.1 NST评分依据一般情况下总评分10~12分为正常，>9分胎儿预后良好，≤9分者再行缩宫素激惹试验，按Ficher评分法统计或配合生物物理监测，按Manning评分法统计。本文对后两种评分不作统计分析，见表1。
1.3.2 Apgar评分 新生儿出生后1、5 min两次评分，4~7分者为轻度窒息，0~3分者为重度窒息。
1.3.3 羊水情况 孕妇入院后若时间允许常规行B超检查，测定羊水指数以预测羊水量。若羊水指数≤50 mm者为羊水过少，50~80 mm者为羊水偏少，≥180 mm为羊水过多。羊水粪染采用Ⅲ级分度[2]，I度者可待自然分娩，Ⅱ或Ⅲ度者及时终止妊娠。
1.4 统计学方法 应用SPSS 10.0统计软件对测量值进行统计，采用χ2检验，检验水准α=0.05。
2 结果
2.1 两组NST图形分析胎心基线率变异包括幅度和频率变异。NST重点观察有无基线变异消失或减弱(<5 次/min)，基线变异在6~25 次/min为正常。高危妊娠组有26例基线变异消失或减弱(74.3%)，同样情况正常组有23例(24.5%)，两组比较差异有显著性(P<0.01)。, http://www.100md.com(彭 可)