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目的探讨羊膜腔输液、羊水置换及羊膜腔输注碱性药物治疗胎儿窘迫酸中毒的临床效果。方法对40例羊水过少、产程中胎心监护出现胎心律异常波形、Ⅱ度以上羊水胎粪污染产妇,在持续内监护下行羊膜腔输液、羊水置换治疗,其中20例分娩前行羊膜腔输入5%NaHCO3150ml(研究组),20例分娩前行静脉注射5%NaHCO3150ml(对照组),分娩后立即抽取两组新生儿脐动脉血行血气分析,并对两组新生儿行Apgar评分比较。结果(1)羊膜腔输液治疗:两组40例产妇中胎心律异常波形消失27例(27/40,68%),胎心律异常波形明显减少8例(8/40,20%),治疗有效率为88%(35/40);无变化或加重5例(5/40,13%)。(2)羊水置换治疗:两组40例产妇平均每例羊水置换Ⅱ~Ⅲ度胎类污染羊水900ml,最少700ml,最多1200ml。经羊水置换后抽出羊水清亮者21例(21/40,53%),羊水Ⅰ度污染者13例(13/40,33%),有效率为85%(34/40);仍有羊水Ⅱ度污染6例(6/40,15%)。(3)研究组脐动脉血二氧化碳分压(PCO2)、氧分压(PO2)、碳酸氢盐(HCO3-)、剩余碱(ABE)、标准碱(SBE)等指标明显好于对照组,两组比较,差异均有统计学意义(P<0·05,P<0·01)。(4)研究组新生儿出生后1分钟Apgar评分平均为(9·2±1·1)分,对照组平均为(8·7±1·7)分,两组比较,差异有统计学意义(P<0·05)。结论羊膜腔输液及羊水置换是治疗因胎儿窘迫及预防新生儿胎粪吸入综合征的有效方法,羊膜腔输注碱性药物能有效纠正胎儿酸中毒。
Objective To investigate the clinical effect of amniotic fluid transfusion, amniotic fluid replacement and amniotic fluid infusion of basic drugs on fetal distress acidosis. Methods 40 cases of oligohydramnios, fetal heart rate guard during labor appear fetal heart rate anomaly waveform, amniotic fluid meconium contamination more than Ⅱ degree of pregnant women, the continued monitoring of the downstream amniotic fluid transfusion, amniotic fluid replacement therapy, of which 20 cases before delivery amniotic cavity Infusion 5% NaHCO3150ml (study group), 20 cases before delivery intravenous injection of 5% NaHCO3150ml (control group), immediately after delivery, two groups of neonatal umbilical artery blood gas analysis, and Apgar score of two groups of newborns were compared. Results (1) In amniotic fluid infusion treatment, 27 cases (27/40, 68%) disappeared in the 40 cases of maternal twins and 8 cases (8/40, 20%) of abnormal fetal heart rhythm waveforms, The effective rate of treatment was 88% (35/40). No change or exacerbation occurred in 5 cases (5 / 40,13%). (2) amniotic fluid replacement therapy: two groups of 40 maternal average each case of amniotic fluid replacement Ⅱ ~ Ⅲ degree of amniotic fluid pollution 900ml, at least 700ml, up to 1200ml. After amniotic fluid replacement, 21 cases (21/40, 53%) had amniotic fluid clear, 13 cases (13/40, 33%) had amniotic fluid Ⅰ degree pollute, the effective rate was 85% (34/40) Degree of pollution in 6 cases (6 / 40,15%). (3) The indexes of PCO2, PO2, HCO3-, ABE and SBE in the study group were significantly better than those in the control group Group, the differences were statistically significant (P <0.05, P <0.01). (4) In the study group, the average Apgar score at 1 minute after birth was (9.2 ± 1.1) points and that in the control group was (8.7 ± 1.7) points. There was significant difference between the two groups (P <0.05). Conclusion Amniotic fluid transfusion and amniotic fluid replacement is an effective treatment for fetal distress and prevention of neonatal meconium aspiration syndrome. Amniotic fluid infusion of basic drugs can effectively correct fetal acidosis.