摘要
目的 探讨胎儿电子监护和脐血流指标与胎儿缺氧和酸中毒的关系。方法 妊娠晚期孕妇 5 47例 ,分娩前 1周内检测脐血流 ,记录S/D比值 (收缩期末最大的血流速度 /舒张期末最大的血流速度 ) ,临产前 1天或临产后行胎心监护。分娩后记录新生儿Apgar评分 ,抽取脐带动脉血作血气分析 ,测定乳酸和超氧化物歧化酶(SOD)值。结果 5 47例产妇均行血气分析 ,40 7例检测乳酸和SOD值 ,2 85例检测脐血流 ;2 39例行产前胎心监护 ,317例行产时胎心监护。经阴道分娩组NST无反应者的 pH明显升高 (P <0 0 1) ,PCO2 和乳酸明显降低 (P<0 0 5 ) ;剖宫产组NST有反应与NST无反应之间的HCO3 -、TCO2 有显著差异 (P <0 0 5 )。产时监护阴性与阳性者的PO2 、HCO3 -、TCO2 、ABE和乳酸均有显著差异 (P <0 0 5 )。S/D比值与PO2 密切相关 (P <0 0 1)。S/D <2 6者和S/D≥ 2 6者两组其SOD值有显著差异 (P <0 0 5 )。Apgar评分 >7分和Apgar评分≤ 7分两组其HCO3 -、TCO2 、ABE (P <0 0 1) ,pH、PCO2 、乳酸均有显著差异 (P <0 0 5 )。结论 在临产前胎心监护发现胎动减少或无胎心加速时 ,提示胎儿缺氧存在 ,发展为代谢性酸中毒尚需一定时间 ,如及时终止妊娠则不发展为酸中毒 ;临产后OCT或CST出现重度变异减速或晚期减速提示?
Objective To analyze the relationship between cardiotocography (CTG),umbilical blood flow parameters and fetal hypoxia acidosis.Methods 547 women in third trimester of pregnancy were collected to receive monitoring of umbilical artery blood flow velocity waveforms within 1 week before delivery( the ratio of the largest blood flow velocities in the systolic phase to that of diastolic phase,that was S/D),in addition,fetal monitoring was performed one day antepartum or intrapartum.Neonatal Apgar scores,umbilical venous blood gas analysis,lactate and superoxide dismutase(SOD) of umbilical blood were examinated after delivery.Results All of the 547 mothers were performed blood gas analysis,407 of them were examined lactate and SOD umbilical blood flow detected in 285 cases;239 were performed antapartum fetal monitoring,317 were monitored intrapartum.In the group of vaginal delivery.pH increased significantly(P<0.01),PCO 2and lactate decreased obviously(P<0.05)compared between NST non-reactive subgroup and reactive one;while in the group of cesarean section, only HCO 3 - and TCO 2 were different(P<0.05).The PO 2, HCO 3 -, TCO 2, ABE,and lactate acid of fetal artery blood were significantly different between groups of negative and positive intrapartum cardiotocography (P<0.05).S/D was closely related with PCO 2 (P<0.01).The difference of SOD between the group of S/D<2.6 and S/D≥2.6 was significant (P<0.05).HCO 3 -?TCO 2?ABE in the Apgar score>7 group was significantly different from those in Apgar score≤7 group (P<0.01).So did the PCO 2?pH?lactate(P<0.05).Conclusion Nonreactive NST is associated with fetal hypoxia,there still exists a period when the hypoxia is developing into acidosis.So the delivery shouldn't be delayed.During labor severe variable decelerations or late decelerations suggests fetal acidosis. The ratio of S/D can predict the change of hemadynamics of uteroplacenta, S/D<2.6 is associated with chronic hypoxia.
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2002年第5期279-282,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家自然基金资助 (基金编号 :3980 0 14 3)
"九五"国家医学科技攻关课题 (编号 :96 -90 4-0 6 -0 4)
