羊水乳酸水平及胎心监护预测胎儿窘迫的价值  

Predictive value of amniotic fluid lactate levels and fetal heart rate monitoring for fetal distress

作　　者：张海鹰[1] 郭晓辉[1] 苏放明[1] 徐宏里[1] 

机构地区：[1]暨南大学医学院二附属医院,深圳518020

出　　处：《中国实用妇科与产科杂志》2005年第1期35-37,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：深圳市科技局科研基金资助 (项目编号 2 0 0 40 40 17)

摘　　要：目的　探讨羊水乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　 2 0 0 3年 8月至 2 0 0 4年 8月暨南大学医学院第二附属医院测定 90例第一产程活跃期出现不良胎儿监护图形 (观察组 )和 10 0例正常胎儿监护图形 (对照组 )的羊水及新生儿脐动脉血乳酸水平 ,其中对照组 30例同时进行母血、脐血及羊水乳酸水平检测。结果　脐血乳酸水平明显高于母血乳酸水平 ,但较羊水为低 (P <0 0 1)。羊水与脐血乳酸水平存在正相关关系(r =0 92 3,P <0 0 1) ,而母血与脐血乳酸水平无相关关系 (r =- 0 15 7,P >0 0 5 )。观察组中自然分娩率低于对照组 (P <0 0 1) ,剖宫产率及新生儿窒息率均高于对照组 (P <0 0 5 )。胎儿监护异常减速羊水乳酸水平为(10 6 0± 1 6 9)mmol/L ,明显高于对照组的 (7 18± 0 91)mmol/L(P <0 0 1) ,轻度变异减速及心动过速羊水乳酸水平分别为 (7 5 0± 1 4 6 )mmol/L ,(7 36± 1 14 )mmol/L ,与对照组比较 ,差异无显著性意义 (P >0 0 5 )。结论　胎儿监护异常减速与胎儿窘迫密切相关。羊水乳酸水平可望成为一种简便、有效的判断胎儿窘迫的生化指标。Objective To discuss the predictive value of lactate levels in amniotic fluid(AF) and abnormal fetal heart rate(FHR)monitoring patterns for fetal distress.Methods From August 2003 to August 2004,there were 90 cases at 37～41 +6 gestational weeks with abnormal FHR monitoring patterns in active phase in observing group in the department of obstetrics and gynecology,the Second Affiliated Hospital of Jinan University.The abnormal patterns included abnormal decelerations,mild variable decelerations and tachycardia.100 cases with normal FHR monitoring patterns served as control.The lactate levels in both AF and umbilical artery were detected.30 women were simultaneously measured for maternal,umbilical plasma and AF lactate levels.Results Fetal plasma lactate levels were significantly higher than that of maternal plasma,but lower than those of AF(P<0 01).The lactate levels of umbilical plasma had positive correlation with those of AF(r=0 923,P<0 01),but not with those of maternal plasma(r=-0 157,P>0 05).The rate of spontaneous labor in observing group was significantly lower than that of the control(P<0 01),the rates of cesarean section and neonatal asphyxia were significantly higher than those of the control(P<0 05).In observing group,the AF lactate levels with abnormal decelerations was(10 60±1 69)mmol/L,significantly higher than the control group's(7 18±0 91)mmol/L(P<0 01).The AF lactate levels with mild variable decelerations and tachycardia were(7 50±1 46)mmol/L,and(7 36±1 14)mmol/L respectively,there were no significant differences with the control group's(P>0 05).Conclusion There is a close correlation between abnormal decelerations and fetal distress.AF lactate levels can be served as an efficient and simple marker to predict fetal distress.

关 键 词：羊水 对照组 胎儿窘迫 脐血 血乳酸 胎儿监护 母血 观察 胎心监护 水平 

分 类 号：R714[医药卫生—妇产科学] R722[医药卫生—临床医学]