足月妊娠羊水胎粪污染在可疑胎儿窘迫剖宫产中的意义  

Significance of meconium-stained amniotic fluid in term cesarean sections indicated by suspected fetal distress

作　　者：李奎[1] 王爽[1] 杨慧霞[1] Li Kui Wang Shuang Yang Huixia.(Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China)

机构地区：[1]北京大学第一医院妇产科,100034

出　　处：《中华围产医学杂志》2017年第3期208-212,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨足月妊娠羊水胎粪污染的临床意义。方法回顾性纳入2012年10月1日至2014年9月30日于北京大学第一医院妇产科单纯以可疑胎儿窘迫为指征所行剖宫产的足月孕妇共857例。按照可疑胎儿窘迫的诊断依据分为3组，单纯羊水Ⅲ度胎粪污染组172例，单纯胎心异常组623例，羊水Ⅲ度胎粪污染同时合并胎一12,异常组62例。比较3组的一般情况及新生儿结局；比较新生儿酸中毒组与无酸中毒组、窒息组与无窒息组、吸入性肺炎组与无吸入性肺炎组之间可能导致新生儿异常结局的因素。采用方差分析、两独立样本t检验、秩和检验及z。检验进行统计学分析。结果3组患者的年龄、分娩孕周、产次、脐带绕颈圈数、脐动脉血pH值、新生儿性别构成差异无统计学意义（P值均〉0．05）。单纯羊水Ⅲ度胎粪污染组新生儿结局包括新生儿Apgar评分、新生儿窒息和生后24h转儿科发生率类似于单纯胎心异常组和羊水Ⅲ度胎粪污染同时合并胎心异常组[1minApgar评分：（9．9±0．7）与（9．8±0．7）和（9．84-0．7）分，F=0．322；5minApgar评分：（10．0±0．3）与（10．0±0．2）和（10．0±0．0）分，F=0．517；新生儿窒息：1．7％（3／172）与2．1％（13／623）和1．6％（1／62），x2=0．129；生后24h转儿科：16-3％（28／172）与14．3％（89／623）和11．3％（7／62），2,2=0．9781，3组问差异无统计学意义（P值均〉0．05）。而且单纯羊水Ⅲ度胎粪污染组新生儿吸入性肺炎的发生率似乎高于单纯胎心异常组和羊水Ⅲ度胎粪污染同时合并胎心异常组[4．7％（8／172）与1．0％（6／623）和3．2％（2／62）]，但3组差异无统计学意义（F=10．680，P=0．050）。结论产程中羊水m度胎粪污染与胎心异常同样具有临床指导意义，一旦发生，均应积极处理以降低新生儿不良结局的发生风险。Objectives To investigate the clinical significance of degree III meconium-stained amniotic fluid in term pregnancy. Methods Data of 857 full-term gravidas underwent cesarean section for suspected fetal distress in Peking University First Hospital from October 1, 2012 to September 30, 2014 were retrospectively analyzed. All patients were divided into three groups according to the diagnosis of suspected fetal distress： meconium-stained amniotic fluid group （Group 1, n=172）, fetal heart abnormality group （Group 2, n=623） and meconium-stained amniotic fluid in combination with fetal heart abnormality group （Group 3, n=62）. General information and fetal prognosis of the three groups were analyzed. Factors that might affect the prognosis of newborns were analyzed between the infants with or without acidosis, asphyxia or aspiration pneumonia. Analysis of variance, independent-samples t test, Chi-square test and rank-sum test were used as statistical methods. Results There were no significant differences in maternal age, gestational age at delivery, parity, nuchal cord loop（s）, pH value of umbilical arterial blood and gender of newborns among the three groups （all P〉0.05）. The neonatal Apgar score, neonatal asphyxia rate and rate of admitting into pediatric ward within 24 hours after birth in Group 1 were similar to those of Group 2 and 3 [ 1 min Apgar score： 9.9 ±0.7 vs 9.8 ±0.7 and 9.8±0.7, F=0.322; 5 rain Apgar score： 10.0±0.3 vs 10.0±0.2 and 10.0±0.0, F=0.517; neonatal asphyxia rate： 1.7% （3/172） vs 2.1% （13/623） and 1.6% （1/62）, x2=0.129; rate of admitting into pediatric ward： 16.3% （28/172） vs 14.3% （89/623） and 11.3% （7/62）, x2=0.978] （all P〉0.05）. The incidence of neonatal aspiration pneumonia in Group 1 was higher than that of Group 2 and 3 [4.7% （8/172） vs 3.2% （2/62） and 1.0% （6/623）], but the differences had no statistical significance （F=10.680, P=0.050）. Conelnslons Both degree Ⅲ meconium-stained amniotic fluid and abnorm

关 键 词：胎儿窘迫 剖宫产术 胎粪吸入综合征 预后 

分 类 号：R719.8[医药卫生—妇产科学]