个体计算机心率指标在检测生长受限胎儿出生时酸血症中的效能。

The efficacy of individual computer heart rate indices in detecting acidemia at birth in growth-restricted fetuses.

作者信息

Guzman E R, Vintzileos A M, Martins M, Benito C, Houlihan C, Hanley M

机构信息

Department of Obstetrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.

出版信息

Obstet Gynecol. 1996 Jun;87(6):969-74. doi: 10.1016/0029-7844(96)00020-8.

DOI:10.1016/0029-7844(96)00020-8

PMID:8649708

Abstract

OBJECTIVE

To determine the efficacy of individual fetal heart rate (FHR) indices, as determined by computer analysis of the FHR tracing, in detecting fetal acidemia at birth in growth-restricted fetuses.

METHODS

The study population consisted of 38 growth-restricted fetuses at 26-37 weeks' gestation from pregnancies with abnormal uterine and/or umbilical artery Doppler velocimetry. The 1-hour FHR tracing was analyzed by computer within 4 hours of cesarean birth before the onset of labor. Umbilical artery cord blood was collected at birth, and pH was determined within 5 minutes of collection.

RESULTS

On linear regression, the duration of episodes of low variation in minutes (r = -0.77, r2 = 0.59) and short-term (r = 0.72, r2 = 0.52) and long-term (r = 0.69, r2 = 0.47) variation in milliseconds were significantly related to umbilical artery pH at birth, and more so than the number of accelerations of ten (r = 0.57, r2 = 0.32) and 15 (r = 0.38, r2 = 0.14) beats per minute. There were significant differences in computer measurements of FHR accelerations and variation between the umbilical artery pH categories of acidemia (pH less than 7.20), preacidemia (7.20-7.25), and nonacidemia (greater than 7.25). Stepwise regression revealed that episodes of low variation best described the model for predicting umbilical artery pH at birth (P < .001), with no improvement provided by the addition of other computer-analyzed FHR characteristics.

CONCLUSION

In this population of growth-restricted fetuses delivered by elective cesarean, the computer indices of duration of episodes of low variation and short-term and long-term variation were significantly associated with umbilical artery pH and predicted umbilical artery acidemia at birth.

摘要

目的

通过对胎儿心率（FHR）描记图进行计算机分析，确定个体FHR指标在检测生长受限胎儿出生时是否存在胎儿酸血症方面的有效性。

方法

研究对象包括38例妊娠26 - 37周的生长受限胎儿，其妊娠伴有子宫和/或脐动脉多普勒血流速度测定异常。剖宫产出生前4小时内（未临产时），由计算机对1小时的FHR描记图进行分析。出生时采集脐动脉血，采集后5分钟内测定pH值。

结果

线性回归分析显示，低变异持续时间（分钟）（r = -0.77，r² = 0.59）、短期变异（r = 0.72，r² = 0.52）和长期变异（r = 0.69，r² = 0.47）（毫秒）与出生时脐动脉pH值显著相关，且比每分钟10次（r = 0.57，r² = 0.32）和15次（r = 0.38，r² = 0.14）加速的次数相关性更强。在酸血症（pH小于7.20）、酸血症前期（7.20 - 7.25）和非酸血症（大于7.25）的脐动脉pH值类别之间，FHR加速和变异的计算机测量值存在显著差异。逐步回归分析显示，低变异持续时间最能描述预测出生时脐动脉pH值的模型（P < 0.001），添加其他计算机分析的FHR特征并不能改善该模型。