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目的通过观察声音刺激引起胎儿的胎动和胎心率的反应及其特点,探索声音刺激能否替代声振刺激及适宜的声强。方法选择2002年4月至2003年2月在浙江大学医学院附属妇产科医院产前检查的正常足月孕妇94例。将孕妇分为5组,分别接受95、100、105、110、115dB不同强度的声音刺激,观察胎儿的胎动和胎心率反应,同时设置空白对照和声振刺激对照。结果(1)95、100、105、110、115dB声音和声振刺激引起胎动的比例分别为15％、89％、83％、83％、95％、99％,其中100、105、110、115dB声音和声振刺激的结果差异无统计学意义。声振刺激引起的胎动强度显著强于115dB声音。(2)100、105、110、115dB声音引起胎心率上升≥15bpm的比例分别为39％、61％、56％、85％。声振刺激总的引起胎心率上升≥15bpm的比例为92％,显著高于100、105、110dB声音,和115dB声音相比差异无统计学意义。(3)五组中声振刺激总的引起胎心率上升的峰值为23bpm,显著高于100、105、110dB声音,而与115dB声音相比差异无统计学意义。(4)声振刺激较115dB声音刺激引起胎儿更长时间的胎心率过速(42．5s和5s,P=0．011)和更长时间的胎动(270s和100s,P=0．000)。结论115dB声音刺激可以引起胎儿有效的胎动和胎心率上升,并避免出现胎儿过度惊吓、胎心率过速和胎动过多,提示在联合NST时,115dB的声音刺激可以替代声振刺激作为胎儿唤醒仪。
Objective To observe whether the sound stimulus can replace the acoustical stimulus and the appropriate sound intensity by observing the reaction of the fetus’s fetal movement and fetal heart rate caused by sound stimulation and its characteristics. Methods From April 2002 to February 2003 in the Department of Obstetrics and Gynecology Hospital of Zhejiang University, prenatal examination of 94 cases of normal pregnant women. Pregnant women were divided into five groups, respectively, to accept 95,100,105,110,115 dB different intensity of sound stimulation to observe the fetus fetal heart rate and fetal heart rate response, while setting the blank control and acoustic stimulation control. Results (1) The proportions of 95,100,105,110,115dB sound-induced tachycardia were 15%, 89%, 83%, 83%, 95% and 99% respectively, of which 100, 105, 110 and 115 dB There was no significant difference in the results of sound and acoustic stimulation. Fetal vibration intensity caused by acoustic stimulation was significantly stronger than the 115dB sound. (2) The proportion of 100, 105, 110, 115 dB sound caused by fetal heart rate increase ≥ 15bpm were 39%, 61%, 56% and 85% respectively. The total rate of fetal heart rate increased by ≥15bpm was 92%, which was significantly higher than that of 100,105,110 dB, which was not statistically different from that of 115 dB sound. (3) In the five groups, the peak value of fetal heart rate rise caused by total acoustic stimulation was 23bpm, which was significantly higher than that of 100,105,110dB, but no significant difference compared with that of 115dB. (4) Fetal vibration (115 s vs 100 s, P = 0.000) was more pronounced than 115 dB acoustically stimulated for a longer fetal heart rate (42.5 s vs 5 s, P = 0.011) and longer ). Conclusion 115dB sound stimulation can cause the fetus to have an effective fetal and fetal heart rate rise, and to avoid fetal over-shock, fetal heart rate and fetal movement too much, suggesting that in conjunction with NST, 115dB of sound stimulation can replace the acoustic stimulation as a fetus Wake instrument.