摘要
目的探讨活跃期羊水乳酸水平对单纯胎心基线变异性降低胎儿窘迫预测价值。方法暨南大学第二附属医院2004年5月至2008年9月,选择162例在活跃期胎心电子监护中出现单纯胎心基线变异性降低的足月、单胎、头位的初产妇,随机分为研究组82例,胎心电子监护同时经阴道取羊水测定乳酸水平;对照组80例仅行胎心电子监护。比较两组的剖宫产率、胎儿窘迫发生率及研究组脐动脉血pH值与出生前1h内羊水乳酸值的相关性。结果研究组脐动脉血pH值与出生前1h内羊水乳酸水平具有明显的负相关性(r=-0.752,P<0.01)。研究组17例脐动脉血pH<7.20者羊水乳酸水平为(11.06±1.82)mmol/L,较脐动脉血pH≥7.20者羊水乳酸水平(7.45±1.19)mmol/L明显升高(P<0.05)。研究组剖宫产率为35.4%,明显低于对照组的52.5%,两者比较差异有统计学意义(P<0.05);研究组脐动脉血pH<7.20发生率较对照组明显降低(分别为20.7%和36.2%),差异有统计学意义(P<0.05);羊水乳酸值>8.9mmol/L为异常值诊断单纯胎心基线变异性降低胎儿窘迫的敏感度、特异度、阳性预测值及阴性预测值分别为82.3%、89.2%、67.0%和95.1%。结论活跃期羊水乳酸监测对单纯胎心基线变异性降低胎儿窘迫有一定预测价值。
Objective To investigate the predictive value of amniotic fluid（AF）lactate levels in parturients with simply decreased fetal heart rate（FHR）baseline variation in active phase for fetal distress.Methods A total of 162 normal parturients admitted in out department with term singleton cephalic presentation fetus between May 2004 and September 2008 were enrolled in this study.Fetus cardiotocography were applied to everyone.Lactate level of amniotic fluid via vagina were examined in observation group（82 cases）while the control group（80 cases）received cardiotocography only.The cesarean rates,fetal distress rates of two groups were compared.Results The neonatal umbilical artery pH value at delivery and lactate level of amniotic fluid were negatively related（r=-0.752,P0.01）.The lactate level of amniotic fluid in those with higher umbilical artery pH value（pH≥7.20）was significantly higher than those with lower umbilical artery pH（P0.05）.The cesarean rate in research group（35.4%）was lower than the control one（52.5%）（P0.05）.The incidence of umbilical artery pH value below 7.20 in research group was also lower（P0.05）.Taking 8.9mmol/L as the upper normal borderline of amniotic lactate level,its sensitivity,specificity,positive predictive value and negative predictive value of fetal distress in parturients with simply decreased fetal heart rate（FHR）baseline variation were 82.3%,89.2%,67.0% and 95.1%,respectively.Conclusion AF lactate measurement may have some value for accurately diagnosing fetal distress in cases with decreased FHR baseline variation during active phase.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2010年第2期132-134,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200404017)
关键词
乳酸
羊水
胎心宫缩监护
胎儿窘迫
lactate
amniotic fluid
cardiotocography
fetal distress
