超聲檢測胚胎心率減慢預測早孕期胚胎妊娠生存結局的研究價值

楊曄潔 張惠 王旭

摘 要 目的：探討孕8周前胚胎心率（EHR）≤100次/min的妊娠生存結局，并評估其預測胚胎流產率的價值。方法：收集2019年2月至2020年12月在門診進行產前檢查的早期妊娠孕婦800例進行超聲檢測，將孕8周前EHR≤100次/min的112例孕婦納入研究，分析胚胎妊娠生存結局。結果：胚胎存活28例，流產84例。胎齡（GA）<8周，EHR≤73次/min，流產率為100%（27/27）；EHR為74～90 次/ min時，流產率約93.47%（43/46）；EHR為91～100 次/min時，流產率約35.9%（14/39）。受試者工作曲線（ROC曲線）分析結果顯示，以EHR為94次/ min預測胚胎流產率，其曲線下面積（AUC）為0.918（P<0.0001），曲線下面積95%可信區間（confidence interval，CI）為0.850～0.961，敏感性及特異性分別為95.24%和82.14%。結論：妊娠早期（孕8周以前），超聲檢測胚胎心率具有重要的臨床意義，可以為臨床預測胚胎妊娠生存結局提供可靠的依據；早孕期EHR越慢，胚胎流產率越高。

關鍵詞 流產；早孕期；胚胎心率；超聲檢測

中圖分類號：R714 文獻標志碼：A 文章編號：1006-1533（2021）20-0034-04

基金項目：上海市松江區科學技術攻關項目（19SJKJ66133）

Research value of ultrasound detection of embryo heart rate slowdown in predicting the pregnancy survival outcomes of early pregnancy

YANG Yejie， ZHANG Hui， WANG Xu

（Maternal and Child Health Care Hospital of Songjiang District， Shanghai 201600， China）

ABSTRACT Objective： To explore the pregnancy survival outcomes of embryonic heart rate（EHR） that were below 100 beats per minute（bpm） before 8 weeks gestational age（GA） and to evaluate the value in predicting the rate of embryo abortion. Methods： Eight hundred pregnant women with early pregnancy who underwent prenatal examination in the clinic from February 2019 to December 2020 were examined by ultrasonography， 112 pregnant women with EHR ≤ 100 times/min before 8 weeks of pregnancy were included in the study to analyze the survival outcome of embryonic pregnancy. Results： There were twenty-eight cases of embryos survival and 84 cases of abortions. GA was less than 8 weeks， EHR was less than 73 times/min， and the abortion rate was 100%（27/27）； when EHR was 74～90 times/min， the abortion rate was about 93.47%（43/46）； when EHR was 91～100 times/min， the abortion rate was about 35.9%（14/39）. The results of receiver operating curve（ROC curve） analysis showed that the area under the curve（AUC） was 0.918（P<0.0001）， the 95% confidence interval（CI） of the area under the curve was 0.850～0.961， and the sensitivity and specificity were 95.24% and 82.14%， respectively. Conclusion： In the early stage of pregnancy（before 8 weeks of pregnancy）， ultrasonic detection of embryonic heart rate has important clinical significance， and it can provide a reliable basis for predicting the survival outcome of embryonic pregnancy； the slower the fetal heart rate in early pregnancy， the higher the embryo abortion rate.

KEY WORDS abortion； early pregnancy； embryonic heart rate； ultrasonic detection