CAJ | 학술논문

目的：分析活跃期和分娩前1 h 的胎心监护图形，探讨产程不同时段的胎心监护图形对于判断新生儿预后的指导意义。方法：选择2014年2月—2014年5月在南京大学医学院附属鼓楼医院经阴道分娩的181例单胎足月初产妇，记录并比较活跃期及分娩前1 h 的胎心监护图形；采用 ROC 曲线分析分娩前1 h 胎心监护图形及第二产程时长对于新生儿预后的指导意义。结果：181例的胎心监护图形中，未出现 III 类图形，分娩前1 h 胎心监护的 I 类图形比例低于活跃期，II 类图形比例高于活跃期，特殊减速图形的比例较活跃期增加，差异均有统计学意义（P ＜0．05）。新生儿不良预后组与新生儿良好预后组相比，活跃期各类图形的差异无统计学意义（P ＞0．05）。分娩前1 h，新生儿不良预后组 II 类图形时长明显长于新生儿良好预后组，而 I 类图形时长短于新生儿良好预后组（P ＜0．05）；不良预后组中发生回复慢、非中度变异减速的比例高于新生儿良好预后组（P ＜0．05）。分娩前1 h II 类图形时长与新生儿预后关系的受试者工作特征（receiver operating characteristic，ROC）曲线下面积为0．646[95％置信区间（95％CI）：0．544～0．748]。结论：分娩前1 h 的胎心监护更容易出现各类减速图形，判读活跃期和分娩前1 h 的胎心监护图形可能需要不同的标准。分娩前1 h II 类图形时长对判断新生儿预后有一定意义，尤其是出现回复慢、非中度变异减速时。第二产程时长与新生儿预后无明显相关性。
목적：분석활약기화분면전1 h 적태심감호도형，탐토산정불동시단적태심감호도형대우판단신생인예후적지도의의。방법：선택2014년2월—2014년5월재남경대학의학원부속고루의원경음도분면적181례단태족월초산부，기록병비교활약기급분면전1 h 적태심감호도형；채용 ROC 곡선분석분면전1 h 태심감호도형급제이산정시장대우신생인예후적지도의의。결과：181례적태심감호도형중，미출현 III 류도형，분면전1 h 태심감호적 I 류도형비례저우활약기，II 류도형비례고우활약기，특수감속도형적비례교활약기증가，차이균유통계학의의（P ＜0．05）。신생인불량예후조여신생인량호예후조상비，활약기각류도형적차이무통계학의의（P ＞0．05）。분면전1 h，신생인불량예후조 II 류도형시장명현장우신생인량호예후조，이 I 류도형시장단우신생인량호예후조（P ＜0．05）；불량예후조중발생회복만、비중도변이감속적비례고우신생인량호예후조（P ＜0．05）。분면전1 h II 류도형시장여신생인예후관계적수시자공작특정（receiver operating characteristic，ROC）곡선하면적위0．646[95％치신구간（95％CI）：0．544～0．748]。결론：분면전1 h 적태심감호경용역출현각류감속도형，판독활약기화분면전1 h 적태심감호도형가능수요불동적표준。분면전1 h II 류도형시장대판단신생인예후유일정의의，우기시출현회복만、비중도변이감속시。제이산정시장여신생인예후무명현상관성。
Objective:To analyze the fetal heart rate tracing patterns in active phase and last hour before delivery,and to ex-plore the indicative role of fetal heart rate tracing patterns in different labor stages in neonatal prognosis.Methods:A total of 181 full-term vaginal delivery primiparas from February 2014 to may 2014 in Nanjing Drum Tower Hospital Affiliated to Nan-jing University Medical School.The fetal heart rate tracing patterns in the active phase and those in the last hour before deliver-y were recorded and compared with each other.Indicative significance of uncertain fetal heart rate tracing patterns duration in the last hour before delivery and long second stage of labor on neonatal prognosis was analyzed with ROC curve.Results:1.No category III fetal heart rate pattern was found in the 181 cases.The proportion of Category I fetal heart rate patterns was lower in the last hour before delivery than that in the active stage while the proportion of category II fetal heart patterns was on the contrary(P <0.05).The proportion of atypical decelerations in the last hour before delivery was significantly higher than that in the active stage(P <0.05).2.In active stage,no significant difference in any category offetal heart patten was found between the favorable prognosis group and the poor prognosis group(P >0.05).3.In the last hour before delivery,duration of category II in the poor prognosis group was longer than that in the favorable prognosis while the duration of category I was on the con-trary(P <0.05).The proportions of slow returns and non-moderate variability were higher in the poor prognosis group(P <0.05).4.The area under the ROC of the relationship between category II duration in the last hour before delivery and neonatal prognosis was 0.646 (95%CI 0.544-0.748).Conclusions:All types of atypical decelerations in fetal heart rate tracing patterns were prone to appear during the last hour before delivery.Different standards may be required to interpret fetal heart rate trac-ing patterns in the active stage and in the last hour before delivery.Category II duration in the last hour before delivery had cer-tain significance in predicting neonatal prognosis,especially the appearance of slow returns and non-moderate variability,while the duration of the second stage of labor had no relationship with neonatal prognosis.