羊水乳酸水平对羊水粪染病例胎儿窘迫的诊断价值  

Diagnostic value of amniotic fluid lactate levels for fetal distress in cases of meconium-stained amniotic fluid.

作　　者：张海鹰[1] 胡芷洋[1] 郭晓辉[1] 付军[1] 苏放明[1] 徐宏里[1] 

机构地区：[1]暨南大学第二临床医学院,深圳518020

出　　处：《中国实用妇科与产科杂志》2005年第8期468-470,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：深圳市科技局科研立项课题(项目编号200404017)

摘　　要：目的探讨羊水乳酸水平在羊水粪染病例中诊断胎儿窘迫的临床价值.方法 2003年8月至2004年12月暨南大学第二临床医学院测定72例第一产程活跃期出现羊水粪染(观察组)和52例羊水清、胎儿监护图形正常且有良好新生儿结局(对照组)的羊水及新生儿脐动脉血乳酸水平.结果对照组羊水乳酸值近似正态分布,其95%参考值为5.4～8.9 mmol/L.对照组活跃期和分娩时羊水乳酸水平差异无显著性意义(P>0.05).羊水Ⅲ度粪染的羊水乳酸水平明显高于对照组(P<0.01).羊水Ⅰ度及Ⅱ度粪染而胎儿监护正常的病例羊水乳酸值与对照组比较,差异无显著性意义(P>0.05).但羊水Ⅱ度粪染合并胎心基线异常或(和)重度变异减速病例的羊水乳酸水平明显升高(P<0.01).观察组发生胎儿窘迫及新生儿窒息的病例,其活跃期羊水乳酸水平均明显高于对照组(P<0.01).以活跃期羊水乳酸值＞8.9mmol/L为异常值来诊断胎儿窘迫发生的敏感性、特异性、阳性预测值及阴性预测值分别为61.9%、88.2%、68.4%和84.9%.结论羊水乳酸值测定对提高羊水粪染病例胎儿窘迫的诊断准确性有一定临床价值.Objective To investigate the diagnostic value of amniotic fluid （AF） lactate levels for fetal distress in cases with meconium-stained AF. Methods A total of 124 parturients with term singleton fetus in the 2nd Hospital of Clinical Medicine of Jinan University from August 2003 to December 2004 were enrolled in this study. Among them, 72 cases of meconium-stained AF during the active phase of labor were taken as observation group, while the other 52 cases of clear AF, normal fetal heart rate monitoring pattern during the labor and satisfying fetal outcome served as control group. All AF lactate levels in active phase and neonatal umbilical artery lactate levels at delivery were measured respectively. Resuits The distribution of AF lactate in control group was nearly normal. Thus the range of normal value for AF lactate was set as 5.4～8.9mmol/L. The AF lactate levels did not alter much during the labor process in control group （ P〈0.05 ）. Compared with the control group, the AF lactate level was significantly higher in severe meconium-stained AF cases （ P〈0.01 ）, while in mild or moderate meconium-stained AF but normal cardiotocography （CTG） cases, there was no obvious difference（ P〉0.05 ）. However, in moderate meconium-stained AF cases of abnormal baseline or/and severe variable deceleration, the AF lactate was much higher than that of control group （P〈0.01）. Among observation group,the AF lactate in active phase in cases of later developed fetal distress or neonatal asphyxia was higher than that in the control group without exception （P〈0.01）. If we adopted AF lactate level to diagnose fetal distress, taking 8.9mmol/L as the upper borderline, its sensitivity .specificity.positive predictive value and negative predictive value were 61.9% ,88.2%, 68.4%, 84. 9%, respectively. Conclusion AF lactate measurement may have some value for accurately diagnosing fetal distress in cases of meconium-stained AF.

关 键 词：乳酸 羊水 羊水粪染 胎儿窘迫 胎儿监测 

分 类 号：R71[医药卫生—妇产科学]