产时胎儿心率变异相关量化参数在胎儿酸血症的预测价值
田宁;陈奕;
摘要(Abstract)：
目的:评估产时胎儿心率变异相关量化参数对于胎儿酸血症的预测能力。方法:回顾分析2018年6月1日至2020年8月31日首都医科大学附属北京妇产医院使用母胎Holter监测的75例患者。分娩后立即抽取脐动脉血,将胎儿酸血症定义为脐动脉血pH<7.20。记录胎儿心电图(FECG)为基础衍生的与胎儿心率变异相关的量化参数,即胎儿心率短变异(STV),胎儿心率高变异周期所占比例(PEHV)、胎儿心率低变异周期所占比例(PELV),分析对比上述3项胎儿心率参数,并计算受试者工作特征曲线(ROC)的曲线下面积(AUC)。结果:共63例入组患者。酸血症组STV[(5.91±1.17)ms]明显低于非酸血症组STV[(8.46±2.05)ms],酸血症组PELV[(17.45±7.86)%]则明显高于非酸血症组PELV[(11.26±5.46)%],差异均有统计学意义(P<0.05)。根据酸血症组及非酸血症组数据绘制ROC曲线并计算AUC值、敏感度、特异度及约登指数,STV分别为0.84、0.94、0.26、0.68,PEHV分别为0.64、0.50、0.19和0.31,PELV为0.71、0.94、0.62、0.32。结论:母胎Holter监测可得到胎儿心率STV、PEHV、PELV变异相关量化参数,胎儿酸血症者中STV明显降低,PELV明显升高,STV及PELV对胎儿酸血症具有预测价值。
关键词(KeyWords)： 母胎Holter监测;胎儿心率变异参数;胎儿酸血症;预测能力
基金项目(Foundation):
作者(Authors): 田宁;陈奕;
DOI: 10.13283/j.cnki.xdfckjz.2022.02.031
参考文献(References)：
- [1] Bailey EJ,Frolova AI,Lopez JD,et al.Mild neonatal acidemia is associated with neonatal morbidity at term[J].Am J Perinat,2021,38(1):155-161
- [2] 中华医学会围产医学分会.电子胎心监护应用专家共识[J].中华围产医学杂志，2015,18(7):486-490
- [3] Ayumu I,Eijiro H,Masahiko N,et al.IPREFACE score:Integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring[J].J Obstet Gynaecol Res,2021,47(4):1305-1311
- [4] Castro L,Loureiro M,Henriques TS,et al.Systematic review of intrapartum fetal heart rate spectral analysis and an application in the detection of fetal acidemia[DB/OL].Swiss Lausanne,Fronters in Pediatrics,(2021-8-2)[2021-9-5].https://doi.org/10.3389/fped.2021.661400
- [5] Zizzo AR,Kirkegaard I,Hansen J,et al.Fetal heart rate variability is affected by fetal movements:a systematic review[DB/OL].Swiss Lausanne,Front Pediat,(2020-9-30)[2021-9-5].https://doi.org/10.3389 /fphys.2020.578898
- [6] Seliger G,Petroff D,Seeger S,et al.Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy[J].J Perinat Med,2017,37(3):231-235
- [7] Pardey J,Moulden M,Redman CW.A computer system for the numerical analysis of nonstress tests[J].Am J Perinat,2002,186(5):1095-1103
- [8] Lepercq J,Nghiem MA,Goffinet F.Fetal heart rate nadir during bradycardia and umbilical artery acidemia at birth[J].Acta Obstet Gynecol Scand,2021,100(5):964-970
- [9] Katebi N,Marzbanrad F,Stroux L,et al.Unsupervised hidden semi-Markov model for automatic beat onset detection in 1D Doppler ultrasound[DB/OL].United Kingdom,Physiological Measurement,(2020-9-18)[2021-9-5],41(8):085007.https://doi.org/10.1088/1361-6579/aba006
- [10] Ezquerro MC,Cornudella RS,Esteban LM,et al.Total intrapartum fetal reperfusion time (fetal resilience) and neonatal acidemia[DB/OL].United Kingdom,J Maternal-Fetal Neonat Med,(2021-5-2)[2021-9-5]:1-10.https://doi.org/10.1080/14767058.2021.1915977