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目的探讨羊水乳酸水平在羊水粪染病例中诊断胎儿窘迫的临床价值。方法2003年8月至2004年12月暨南大学第二临床医学院测定72例第一产程活跃期出现羊水粪染(观察组)和52例羊水清、胎儿监护图形正常且有良好新生儿结局(对照组)的羊水及新生儿脐动脉血乳酸水平。结果对照组羊水乳酸值近似正态分布,其95%参考值为5.4~8.9mmol/L。对照组活跃期和分娩时羊水乳酸水平差异无显著性意义(P>0.05)。羊水Ⅲ度粪染的羊水乳酸水平明显高于对照组(P<0.01)。羊水Ⅰ度及Ⅱ度粪染而胎儿监护正常的病例羊水乳酸值与对照组比较,差异无显著性意义(P>0.05)。但羊水Ⅱ度粪染合并胎心基线异常或(和)重度变异减速病例的羊水乳酸水平明显升高(P<0.01)。观察组发生胎儿窘迫及新生儿窒息的病例,其活跃期羊水乳酸水平均明显高于对照组(P<0.01)。以活跃期羊水乳酸值>8.9mmol/L为异常值来诊断胎儿窘迫发生的敏感性、特异性、阳性预测值及阴性预测值分别为61.9%、88.2%、68.4%和84.9%。结论羊水乳酸值测定对提高羊水粪染病例胎儿窘迫的诊断准确性有一定临床价值。
Objective To investigate the clinical value of amniotic fluid lactate levels in the diagnosis of fetal distress in cases of meconium-stained amniotic fluid. Methods From August 2003 to December 2004, 72 cases of amniotic fluid meconium (observation group) and 52 cases of amniotic fluid were observed during the active stage of the first stage of labor in the Second Clinical College of Jinan University from August 2003 to December 2004. The fetus monitoring pattern was normal and had a good neonatal outcome Control group) of amniotic fluid and neonatal umbilical artery lactate levels. Results The amniotic fluid lactic acid value in the control group was approximately normal distribution with a 95% reference value of 5.4- 8.9 mmol / L. There was no significant difference in the amniotic fluid lactate levels between the control group and active labor (P> 0.05). Amniotic fluid Ⅲ stool dyeing amniotic fluid lactic acid levels were significantly higher than the control group (P <0.01). Amniotic fluid Ⅰ degree and Ⅱ degree meconium stained and fetal custody cases of normal amniotic fluid lactate levels compared with the control group, no significant difference (P> 0.05). However, amniotic fluid Ⅱ meconium stained with fetal heart rate baseline abnormalities or (and) severe degeneration of amniotic fluid lactic acid levels were significantly higher (P <0.01). In the observation group with fetal distress and neonatal asphyxia cases, the active amniotic fluid lactate levels were significantly higher than the control group (P <0.01). The sensitivity, specificity, positive predictive value and negative predictive value were 61.9%, 88.2%, 68.4% and 84.9%, respectively. The abnormal value of amniotic fluid lactic acid value> 8.9mmol / L was used to diagnose fetal distress. Conclusion Determination of amniotic fluid lactate value for improving the diagnostic accuracy of fetal distress in cases of meconium amniotic fluid has some clinical value.