超声检测胚胎心率减慢预测早孕期胚胎妊娠生存结局的研究价值

杨晔洁 张惠 王旭

摘 要 目的：探讨孕8周前胚胎心率（EHR）≤100次/min的妊娠生存结局，并评估其预测胚胎流产率的价值。方法：收集2019年2月至2020年12月在门诊进行产前检查的早期妊娠孕婦800例进行超声检测，将孕8周前EHR≤100次/min的112例孕妇纳入研究，分析胚胎妊娠生存结局。结果：胚胎存活28例，流产84例。胎龄（GA）<8周，EHR≤73次/min，流产率为100%（27/27）；EHR为74～90 次/ min时，流产率约93.47%（43/46）；EHR为91～100 次/min时，流产率约35.9%（14/39）。受试者工作曲线（ROC曲线）分析结果显示，以EHR为94次/ min预测胚胎流产率，其曲线下面积（AUC）为0.918（P<0.0001），曲线下面积95%可信区间（confidence interval，CI）为0.850～0.961，敏感性及特异性分别为95.24%和82.14%。结论：妊娠早期（孕8周以前），超声检测胚胎心率具有重要的临床意义，可以为临床预测胚胎妊娠生存结局提供可靠的依据；早孕期EHR越慢，胚胎流产率越高。

关键词 流产；早孕期；胚胎心率；超声检测

中图分类号：R714 文献标志码：A 文章编号：1006-1533（2021）20-0034-04

基金项目：上海市松江区科学技术攻关项目（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