CAJ | 학술논문

目的：研究当CTG正常及出现各种胎儿窘迫波形时脐动脉血流变化情况；分析各组中脐动脉最大最小血流速度之比（S／D ）值与胎儿窘迫的关系；评价两种方法联合应用对胎儿窘迫的诊断有何益处。方法选择足月临床孕妇300例，在产时行CTG ，其中胎心监护出现异常者，分为晚期减速组（1ate deceleration group ，LD组）35例及重度变异减速组（severe varia‐ble deceleration group ，SVD组）47例，对两组的孕妇分别行产时彩色多普勒脐动脉血流分析，测量其宫缩期及间歇期的最小血流速度（MIN）、最大血流速度（MAX）、S／D、阻力指数（最大最小速度差与最大速度之比，RI），产后观察有无胎儿窘迫，并比较单独使用CTG或S／D值及联合使用两种方法预测胎儿窘迫的敏感性、特异性、阳性预测值，阴性预测值。结果正常组与SVD组、LD组（35例）两组分别比较M IN、S／D和RI之间均有差异；正常组与SVD组、LD组分别比较，SVD组与LD组两组比较，胎儿窘迫的发生率有统计学差异；宫缩间歇期脐动脉S／D值对胎儿窘迫的预测的特异性较高，而其敏感性较低，CTG联合S／D对胎儿窘迫的预测的特异性和敏感性无明显提高；但CTG联合S／D可提高对胎儿窘迫的阳性预测值。结论单纯应用产时脐动脉S／D值筛查胎儿窘迫有较大缺陷，但CTG联合S／D可降低CTG的假阳性，减少不必要的剖宫产，是胎儿窘迫诊断的有益补充。
목적：연구당CTG정상급출현각충태인군박파형시제동맥혈류변화정황；분석각조중제동맥최대최소혈류속도지비（S／D ）치여태인군박적관계；평개량충방법연합응용대태인군박적진단유하익처。방법선택족월림상잉부300례，재산시행CTG ，기중태심감호출현이상자，분위만기감속조（1ate deceleration group ，LD조）35례급중도변이감속조（severe varia‐ble deceleration group ，SVD조）47례，대량조적잉부분별행산시채색다보륵제동맥혈류분석，측량기궁축기급간헐기적최소혈류속도（MIN）、최대혈류속도（MAX）、S／D、조력지수（최대최소속도차여최대속도지비，RI），산후관찰유무태인군박，병비교단독사용CTG혹S／D치급연합사용량충방법예측태인군박적민감성、특이성、양성예측치，음성예측치。결과정상조여SVD조、LD조（35례）량조분별비교M IN、S／D화RI지간균유차이；정상조여SVD조、LD조분별비교，SVD조여LD조량조비교，태인군박적발생솔유통계학차이；궁축간헐기제동맥S／D치대태인군박적예측적특이성교고，이기민감성교저，CTG연합S／D대태인군박적예측적특이성화민감성무명현제고；단CTG연합S／D가제고대태인군박적양성예측치。결론단순응용산시제동맥S／D치사사태인군박유교대결함，단CTG연합S／D가강저CTG적가양성，감소불필요적부궁산，시태인군박진단적유익보충。
Objective To study the fetal distress waveform happens when normal CTG and umbilical artery blood flow chan‐ges:analysis between groups in the ratio of the maximum minimum blood flow velocity (S/D) value and the correlation of fetal distress ;Joint application evaluation two methods can improve the diagnosis level of intrapartum fetal distress .Methods Clini‐cal pregnant women ,300 cases of full term ,in their production with initiative ,including cardiac care appear abnormal ,divided into late deceleration group (1 ate deceleration group ,LD group) 35 cases and severe variation reduction group (severe variable deceleration group ,SVD group) and 47 cases ,the abnormal cardiac monitoring group and normal control group of pregnant women when the production line of color doppler umbilical artery blood flow analysis ,measuring its contractions and break the maximum blood flow velocity (MAX) ,minimal blood flow velocity (MIN) ,resistance index (the ratio of the maximum differ‐ential minimum speed and maximum speed ,RI) ,S/D ,postpartum and observe the presence of fetal distress ,and compare the used alone with initiative or S/D value and combination of the two methods to predict fetal distress sensitivity ,specificity ,posi‐tive predictive value ,negative predictive value .Results The SVD ,LD group and normal group (35 cases) in the two groups were compared between MIN ,S/D and RI difference ;The SVD ,LD group and normal group respectively ,SVD group compared with LD group two groups ,the incidence of fetal distress was statistically difference ;Contractions are intermittent period of umbilical artery S/D value of fetal distress prediction specificity ,the highest and the lowest sensitivity ,CTG joint S/D specific‐ity and sensitivity of fetal distress prediction of improved obviously ;But with initiative joint S/D can improve the positive pre‐dictive value 94 .6% respectively .Conclusion Simple application intrapartum umbilical artery S/D value in the diagnosis of fetal distress have larger defects ,but with initiative joint S/D can reduce the false positive of CTG ,reduce unnecessary cesarean sec‐tion ,fetal distress diagnosis is a beneficial supplement .