NST中Type O-dip波或V型棘波对脐带缠绕价值的评 |
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【关键词】 无负荷试验
【摘要】 目的 探讨胎儿监护无负荷试验（NST）中Type O-dip波或V型棘波对脐带缠绕的诊断及分娩处理中的价值。方法 选择2003年7月～2005年4月入院时未临产足月单胎头位妊娠、B超检查羊水量正常、无妊娠合并症和并发症的孕妇1240例，进行NST，出现Type O-dip波或V型棘波预测为脐带缠绕，同时追踪其妊娠结局。将产后证实脐带缠绕病例进行分组，NST中伴随每次胎动出现Type O-dip波或V型棘波纳入频发组；伴随胎动出现并非每次出现Type O-dip波或V型棘波纳入散发组；无Type O-dip波或V型棘波纳入对照组，并将各组中胎儿窘迫、新生儿窒息、剖宫产等发生率进行分析对比。结果 足月单胎头位脐带缠绕发生率21.05%，NST中Type O-dip波或V型棘波预测脐带缠绕，阳性预测值95.6%，阴性预测值93.7%，敏感性78.5%，特异性99.1%，准确性94.0%，NST中Type O-dip波或V型棘波频发组与散发组及对照组比较，胎儿窘迫、新生儿窒息及剖宫产发生率差异有显著性（P均＜0.05）；散发组与对照组比较，胎儿窘迫、新生儿窒息及剖宫产发生率差异无显著性（P＞0.05）。结论 NST中Type O-dip波或V型棘波预测脐带缠绕有较高准确性，是一种简单、经济、重复性强的诊断方法。对NST中频发Type O-dip波或V型棘波者适当放宽剖宫产指征，能有效降低新生儿窒息率，提高新生儿质量。
【关键词】 无负荷试验；脐带缠绕；胎儿窘迫；新生儿窒息；剖宫产
Appraisal of the value of Type O-dip wave or V-spike wave in nonstress testing to umbilical cord entanglement
【Abstract】 Objective To explore the value of Type O-dip wave or V-spike wave during nonstress testing(NST）for diagnosis of umbilical cord entanglement and parturition disposal.Methods 1240 cases of singtetion pregnancy with head birth,normal amniotic fluid and no complication of pregnancy during gestational ages of 37～42 weeks underwent NST before delivery,when admitted between July 2003 and April 2005.If Type O-dip wave or V-spike wave were observed,umbilical cord entanglement was prognosticated,at the same time,their pregnancy result were followed up,Cases which were confirmed to be umbilical cord entanglement and Type O-dip wave or V-spike wave with fetal movement were always observed during NST,were involved in the high frequency group;if Type O-dip wave or V-spike wave being not observed in every fetal movement were involved in the chisperse group;other cases in which Type O-dip wave or V-spike wave were not observed,were involved in the control group.In the end,very groups were compared and analyzed with regard to fetal distress,neonatal asphyxia and cesarean section.Results For nature singletion pregnancy with head birth,the rate of umbilical cord entanglement was 21.05%.When prognosing umbilical cord entanglement by Type O-dip wave or V-spike wave during NST,the positive predict value was 95.6%,the negative predict value was 93.7%,the sensitivity was 78.5%,the specificity was 99.1%,and the rate of accuracy was 94%.When compared with the disperse group and the control group,it was significantly higher(P＜0.005）in high frequency group with regard to the rate of fetal distress,neonatal asphyxia and cesarean section.But betwen the disperse group and control group,there was no obvious diflerence(P＞0.05）.Conclusion The rate of accuracy of prognosing umbilical cord entanglement by Type O-dip wave or V-spike wave during NST,which is sample,economic and repeatable means of diagnosis, was very high.For those with Type O-dip wave or V-spike wave occuring frequently during NST,widening implications of cesarean section properly will reduce the rate of neonatal asphyxia effectually,and accordingly improve quality of neonatal.
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