新生儿代谢性酸中毒与产时胎心减速的回顾性分析  

Retrospective Analysis of Neonatal Metabolic Acidosis and Fetal Heart Rate Deceleration

作　　者：毛玉慧[1] 马璠[1] 师艳[1] MAO Yuhui;MA Fan;SHI Yan(Yuxi People’s Hospital,Yuxi City,Yunnan Province 653100)

机构地区：[1]云南省玉溪市人民医院,653100

出　　处：《医学理论与实践》2020年第22期3713-3715,3709,共4页The Journal of Medical Theory and Practice

摘　　要：目的:通过回顾性分析发生代谢性酸中毒新生儿产时胎心监护图形中胎心减速图形的特征,为临床医生在处理产时胎心减速图形时提供参考,减少不良分娩结局的发生。方法:回顾性收集2016年1月—2019年9月在我院足月单胎经阴道分娩后发生新生儿代谢性酸中毒的患儿299例,产时持续电子胎心监测。其中发生变异减速组(A组)186例、晚期减速组(B组)73例、变异减速合并晚期减速组(C组)40例,分析并比较各组间新生儿脐动脉血pH值、减速后胎心率最低值、减速持续时间、减速占宫缩百分比四个指标以及三种减速引起新生儿代谢性酸中毒严重程度的比较。结果:A组与B组间新生儿脐动脉血pH值无统计学差异(P=0.716),C组与A、B两组间差异均有统计学意义(P均<0.05)。减速后胎心率最低值A、B、C三组间差异均有统计学意义(P均<0.05)。减速持续时间A、B、C组三组间差异无统计学意义(P均>0.05)。A、B、C三组间减速占宫缩的百分比差异均无统计学意义(P均>0.05)。结论:在减速持续时间以及减速占宫缩比例无显著性差异的情况下,变异减速合并晚期减速比单纯的变异减速、晚期减速引起的新生儿代谢性酸中毒更严重。同时,当变异减速、晚期减速、变异减速合并晚期减速占宫缩比例达到35%时可能引起严重的新生儿代谢性酸中毒,应引起临床医生的高度重视,尽快结束分娩,避免不良分娩结局的发生。Objective:Through retrospective analysis of the characteristics of the fetal heart rate deceleration pattern of the fetal heart rate monitoring pattern of the newborn with metabolic acidosis,it can provide reference for the clinician in dealing with the fetal heart rate deceleration pattern of the newborn during the delivery and minimize the occurrence of adverse delivery outcomes.Methods:From January 2016 to September 2019,299 cases of neonatal metabolic acidosis after parturition were collected.186 cases in group A,73 cases in group B and 40 cases in group C were analyzed and compared.The correlation between the three indexes and metabolic acidosis was analyzed.Results:There was no significant difference in the blood pH of umbilical artery in neonates between group A and group B(P=0.716),and between group C and groups A and B(P<0.05).The differences of the lowest fetal heart rate among the three groups were statistically significant(P<0.05).There was no significant difference of the duration of deceleration among the three groups(P>0.05).There was no significant difference in the proportion of deceleration to uterine contraction among the three groups(P>0.05).Conclusion:In the case of no significant difference in the duration of deceleration and the proportion of deceleration to uterine contraction,the metabolic acidosis of newborn caused by variant deceleration combined with late deceleration is more serious than that caused by variant deceleration and late deceleration.At the same time,when the rate of mutation deceleration,late deceleration,mutation deceleration combined with late deceleration accounts for 35%of uterine contraction,it may cause serious neonatal metabolic acidosis,which should be paid great attention to by clinicians,and the delivery should be ended as soon as possible to avoid the occurrence of adverse delivery outcomes.

关 键 词：新生儿代谢性酸中毒 电子胎心监护 变异减速 晚期减速 

分 类 号：R722.1[医药卫生—儿科]