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目的 探讨羊水乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法 2 0 0 3年 8月至 2 0 0 4年 8月暨南大学医学院第二附属医院测定 90例第一产程活跃期出现不良胎儿监护图形 (观察组 )和 10 0例正常胎儿监护图形 (对照组 )的羊水及新生儿脐动脉血乳酸水平 ,其中对照组 30例同时进行母血、脐血及羊水乳酸水平检测。结果 脐血乳酸水平明显高于母血乳酸水平 ,但较羊水为低 (P <0 0 1)。羊水与脐血乳酸水平存在正相关关系(r =0 92 3,P <0 0 1) ,而母血与脐血乳酸水平无相关关系 (r =- 0 15 7,P >0 0 5 )。观察组中自然分娩率低于对照组 (P <0 0 1) ,剖宫产率及新生儿窒息率均高于对照组 (P <0 0 5 )。胎儿监护异常减速羊水乳酸水平为(10 6 0± 1 6 9)mmol/L ,明显高于对照组的 (7 18± 0 91)mmol/L(P <0 0 1) ,轻度变异减速及心动过速羊水乳酸水平分别为 (7 5 0± 1 4 6 )mmol/L ,(7 36± 1 14 )mmol/L ,与对照组比较 ,差异无显著性意义 (P >0 0 5 )。结论 胎儿监护异常减速与胎儿窘迫密切相关。羊水乳酸水平可望成为一种简便、有效的判断胎儿窘迫的生化指标。
Objective To investigate the value of amniotic fluid lactate levels and fetal heart rate monitoring fetal distress prediction. Methods From August 2003 to August 2004, 90 pregnant women with adverse fetal monitoring patterns (observation group) and 100 normal fetus monitoring patterns in the active stage of the first stage of labor were measured in the Second Affiliated Hospital of Jinan University Medical College Control group) of amniotic fluid and neonatal umbilical artery lactate levels, including 30 cases of control group at the same time maternal blood, umbilical cord blood and amniotic fluid lactate levels. Results The umbilical blood lactate level was significantly higher than that of maternal blood lactate, but lower than amniotic fluid (P <0.01). There was a positive correlation between amniotic fluid and umbilical blood lactate levels (r = 0 92 3, P 0 01), while there was no correlation between maternal blood and umbilical cord blood lactate levels (r = - 0 15 7, P 0 05). The rate of spontaneous delivery in the observation group was lower than that in the control group (P <0.01), and the rate of cesarean section and neonatal asphyxia were higher than those in the control group (P <0.05). The level of amniotic fluid lactate was significantly lower than that of the control group (10 6 ± 1 6 9) mmol / L, (7 18 ± 0 91) mmol / L (P 0 01), mild deceleration and The levels of amniotic fluid and lactic acid in tachycardia were (75 ± 1 46) mmol / L and (7 36 ± 1 14) mmol / L, respectively. There was no significant difference between the two groups (P> 0.05). Conclusion Fetal monitoring abnormal deceleration and fetal distress are closely related. Amniotic fluid lactic acid level is expected to become a simple and effective biochemical indicators to determine fetal distress.