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目的探讨产时胎心监护联合脐血pH值测定及新生儿Apgar评分用于预测新生儿结局的临床价值。方法选取2014年1月-2016年6月在该院住院分娩的产妇500例作为研究对象,胎心监护异常的198例产妇为观察组,胎心监护正常的302例产妇为对照组。比较两组新生儿出生时脐血pH值、Apgar评分,评价胎心监护联合脐血pH值及Apgar评分在新生儿结局预测中的价值。结果观察组的脐血pH值(7.12±0.17vs.7.22±0.15)及Apgar评分(7.73±1.86vs.8.86±1.38)明显低于对照组,剖宫产率(32.3%vs27.8%)及器械助产率(16.2%vs.9.93%)明显高于对照组,新生儿缺氧缺血性脑病(HIE)发生率明显高于对照组(11.6%vs.6.29%);pH值越低、Apgar评分越低HIE的发生率越高;胎心监护、脐血pH值、Apgar评分各自对于新生儿HIE的预测价值均不理想,三者联合应用(异常胎心监护+pH<7.2+Apgar≤7)对于预测新生儿HIE的特异度高达96.5%,阴性预测值高达97.6%。结论产时胎心监护、脐血pH、Apgar评分三者均是评估胎儿及新生儿出生缺氧状态有价值的指标,三者结合预测评价新生儿结局,能获得较高的准确率,为及早采取有效的治疗措施提供可靠依据。
Objective To investigate the clinical value of labor during fetal heart rate monitoring combined with umbilical cord blood pH and neonatal Apgar score in predicting neonatal outcome. Methods From January 2014 to June 2016, 500 maternal hospitalized in this hospital were selected as the research object. The 198 pregnant women with abnormal fetal heart rate were selected as observation group and 302 normal pregnant women with fetal heart rate as control group. To compare the value of neonatal umbilical cord blood pH, Apgar score, fetal heart rate monitoring combined with umbilical cord blood pH value and Apgar score in neonatal outcome prediction. Results The values of umbilical blood pH in the observation group (7.12 ± 0.17 vs.7.22 ± 0.15) and Apgar score (7.73 ± 1.86 vs.8.86 ± 1.38) were significantly lower than those in the control group (32.3% vs27.8%) and The rate of device assisted abortion (16.2% vs.9.93%) was significantly higher than that of the control group. The incidence of neonatal hypoxic-ischemic encephalopathy (HIE) was significantly higher than that of the control group (11.6% vs.6.29% The lower the Apgar score was, the higher the incidence of HIE was. Fetal heart monitoring, umbilical cord blood pH and Apgar scores were not satisfactory for predicting HIE in neonates. The combination of the three (abnormal fetal heart monitoring + pH <7.2 + Apgar≤ 7) The specificity for predicting neonatal HIE is as high as 96.5% and the negative predictive value is as high as 97.6%. Conclusion During labor, fetal heart rate monitoring, umbilical blood pH, and Apgar score are all valuable indicators for assessing neonatal hypoxia status. The combination of these three predictors of neonatal outcome provides a high accuracy rate To take effective treatment to provide a reliable basis.