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目的探讨第二产程胎心电子外监护和母体心率联合监测的临床价值。方法将2003年1月至2004年12月在暨南大学第二附属医院分娩的403例足月孕妇随机分为联合1组(160例)、联合2组(83例)和对照组(160例)。各组在宫口开大7~8cm时分别应用胎心电子外监护、孕妇母体心率监测和胎儿头皮电极内监护直至分娩。记录3组的真性图形、重合图形、自然分娩率、阴道手术率、剖宫产率与新生儿窒息情况。结果联合Ⅰ组、联合Ⅱ组重合图形均多于对照组,差异有非常显著性意义(P<0·01),联合1组和联合2组间真性图形和重合图形的发生率差异无显著性意义(P>0·05);对照组因没有对母亲心率进行同步监测,所以无重合图形出现;联合1组自然分娩率高于对照组(96·9%vs86·3%,P<0·01),剖宫产率及阴道手术产率均低于对照组(P<0·05);3组间新生儿窒息率差异无显著性意义(P>0·05)。结论产程中联合应用连续胎心电子外监护和孕妇母体心率监测是一种无创和简易的监护手段,能避免内监护造成的损伤并能有效地发现重合图形。
Objective To investigate the clinical value of combined fetal heart rate monitoring and maternal heart rate monitoring in the second stage of labor. Methods A total of 403 full-term pregnant women delivered at the Second Affiliated Hospital of Jinan University from January 2003 to December 2004 were randomly divided into 1 group (160 cases), 2 cases (83 cases) and control group (160 cases) . Each group in the cervix to open a large 7 ~ 8cm fetal heart rate monitoring, maternal heart rate monitoring and fetal scalp electrode monitoring until delivery. Record 3 groups of true graphics, coincidence graphics, natural delivery rate, vaginal surgery rate, cesarean section rate and neonatal asphyxia. Results Compared with the control group, the number of coincidences in group Ⅰ and group Ⅱ was significantly higher than that in control group (P <0.01). There was no significant difference in the incidence of true and overlapping images between group 1 and group 2 (P> 0.05). In the control group, no coincidence graph was found because the heart rate of the mother was not monitored synchronously. The spontaneous delivery rate in the combined group 1 was significantly higher than that in the control group (96.9% vs 86.3%, P <0. 01), cesarean section rate and vaginal surgery rate were lower than the control group (P <0.05); no significant difference in asphyxia between the three groups (P> 0.05). Conclusion The combination of continuous fetal heart rate monitoring and maternal heart rate monitoring in the labor course is a non-invasive and simple monitoring method that can avoid the damage caused by internal monitoring and can effectively find the coincidence pattern.