摘要
目的：研究脐动脉血乳酸水平与产时胎心监护不良图形及新生儿结局之间的关系。方法：229例足月妊娠、单胎、头位产妇根据产时胎心宫缩图（cardiotocography，CTG）分为两组，观察组：轻度变异减速（variable deceleration，VD）68例、不良CTG包括中、重度VD、不典型VD、胎心基线变异减弱或消失、延长减速、重度晚期减速及心动过缓84例。对照组：产时CTG无VD及不良图形、新生儿脐动脉血pH≥7．20的产妇77例，检测新生儿脐动脉血乳酸浓度及生后20项行为神经评分（neonatal behavioral neudogioal assessment，NBNA）。结果：对照组脐动脉血乳酸99％参考值范围为1．31～4．05mmol／L，不良CTG脐血乳酸水平明显高于对照组（P〈0．01）；pH、BE值显著低于对照组与轻度VD组（P〈0．01，P〈0．05），脐血乳酸水平与pH、BE呈显著负相关（P〈0．01）。以对照组面±2．58s为界值，观察组脐血乳酸超过界值者不良CTG占73．33％，其中不良结局儿占68．18％。结论：脐动脉乳酸水平与pH、BE值有较好的相关性。产时重度VD或VD并存其它异常CTG，胎心基线变异减弱，尤其伴发羊水粪染、脐带异常时与围生儿脐血高乳酸水平、不良结局有关。
Objective：To study the relations between the umbilical artery lactate levels, intrapartum cardiotocography （CTG） and newborn outcomes. Methods：Depending on the intrapartum cardiotocography,229 term parturients with cephalia precentation and singleton fetus were divided into two groups. In observing group, there were 68 cases with mild variable decelerations（VD） and 84 cases with ominous fetal heart rate patterns, which included moderate to severe variable decelerations, severe late deceleration, prolong deceleration, minimal/absent baseline variability and bradycardia. In control group, there were 77 cases with normal cardiotocography and umbilical artery blood pH ≥ 7.20. The lactate value and acid-base balance were measured at each delivery. At 4 - 6th and 26 - 28th day after birth, neonatal behavioral neudogioal assessment （NBNA） was taken for each newborn. Results：Compared with that of the control group,the lactate level of the ominous CTG group was significantly higher（P 〈0.01 ）. In the ominous CTG group, the lactate levels was negatively correlated with pH value and base excess （BE） （ P 〈 0.01, P 〈 0.05 ）. If the levels of x^- ± 2. 58s were chosen as cut off value in the control group,there were 30 cases （73.33%） with ominous CTG in the observing group whose cord blood lactate levels were 〉4.05mmol/L,of which 68.18% was poor outcome newhorns. Conclnsions：The study indicates a close correlation between lactate levels and the umbilical artery blood pH, BE in patients with ominous fetal heart rate patterns. An increment lactate concentrations are also found in ominous CTG group. There may be relationship between severe VD or VD complicated by other abnormal decelerations, minimal baseline variability, especially with intrapartum meconium-staind amniotic fluid and cord complications, and higher lactate levels in cord blood and poor neonatal outcomes.
出处
《现代妇产科进展》
CSCD
北大核心
2007年第3期214-216,219,共4页
Progress in Obstetrics and Gynecology
基金
青岛市科技发展计划项目(05-2-NS-43)
关键词
脐动脉
乳酸
胎心分娩描记法
缺氧
酸中毒
新生儿结局
Umbilical arteries
Lactic acid
Cardiotocography
Anoxia
Acidosis
Newborn outcome
