脐血乳酸水平及胎心监护图形预测胎儿窘迫的价值

目的　探讨新生儿脐动脉血乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　测定 73例胎心监护图形为不良图形 (胎心基线异常、重度变异减速、轻度变异减速、心动过速 )的新生儿(病例组 )和 118例产前无胎儿窘迫征象 ,出生后 1分钟Apgar评分≥ 9分的新生儿 (对照组 )出生后脐动脉血乳酸水平。结果　病例组中产钳助产率明显高于对照组 (P <0 0 1) ,顺产率低于对照组 (P<0 0 1)。病例组中 ,胎心重度变异减速多发于第二产程 ;胎心基线异常的新生儿Apgar评分≤ 7分的发生率高于重度变异减速、轻度变异减速、心动过速的新生儿 (P <0 0 5 )。病例组中 ,胎心基线异常者脐动脉血乳酸水平为 (4 5 5± 0 2 3 )mmol/L ;重度变异减速者为 (3 84± 0 40 )mmol/L ,出现以上两种图形的新生儿脐动脉血乳酸水平均明显高于对照组 (P <0 0 1)。轻度变异减速者脐动脉血乳酸水平为 (2 63± 0 3 2 )mmol/L ;心动过速者脐动脉血乳酸水平为 (2 5 5± 0 46)mmol/L。并且轻度变异减速与心动过速者脐动脉血乳酸水平与对照组比较 ,差异无显著性 (P >0 0 5 )。结论　测定新生儿脐动脉血乳酸水平是一种有效、准确的诊断胎儿窘迫的方法。胎心基线异常、重度变异减速与胎儿窘迫的发生密切相关 ;轻度变异减速、心动过速与胎

Predictive value of umbilical artery lactate levels and fetal heart rate monitoring for fetal distress

OBJECTIVE: Measuring umbilical artery lactate levels to evaluating the predictive value of abnormal fetal heart rate (FHR) monitoring patterns for fetal distress. METHODS: There were 73 neonates with abnormal fetal heart monitoring patterns in the distress group. The abnormal patterns included abnormal baseline FHR, severe variable decelerations, mild variable decelerations and tachycardia. There were 118 normal neonates (Apgar score > or = 9) in the control group. Twenty min fetal heart monitoring was performed at the time of admitting, laboring and in labor and in active phase. Continuous fetal heart monitoring was performed during the second stage of labor. All neonatal umbilical artery lactate levels were measured at delivery. RESULTS: The rate of using forceps in distress group was significantly higher than that of the control (P < 0.01), the rate of spontaneous labor was significantly lower than the control group (P < 0.01). In the distress group, severe variable decelerations were generally emerged in the second stage of labor. The incidence of neonatal Apgar score < or = 7 in neonates with abnormal baseline FHR was higher than those with severe variable decelerations, mild variable decelerations and tachycardia (P < 0.05). As for neonatal umbilical artery lactate levels, the neonatatuses with abnormal baseline FHR was (4.55 +/- 0.23) mmol/L, the neonatatuses with severe variable decelerations was (3.84 +/- 0.40) mmol/L, all significantly higher than the control group's (P < 0.01). The neonatatuses with mild variable decelerations was (2.63 +/- 0.32) mmol/L, the neonatatuses with tachycardia was (2.55 +/- 0.46) mmol/L, and there are no significant differences between the neonatatuses with mild variable decelerations and tachycardia and the control group's (P > 0.05). CONCLUSIONS: Measuring umbilical artery lactate levels is an efficient and accurate technique for fetal distress diagnosis. There was a close correlation between baseline FHR with abnormal changes and severe variable deceleration with fetal distress. There was no certainly correlation between mild variable decelerations and tachycardia with fetal distress. It should be evaluated later.