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目的:探讨妊娠期肝内胆汁淤积症(ICP)孕妇胎儿肺损伤与血清总胆汁酸(TBA)水平的相关性。方法:随机抽选50例在该院剖宫产分娩的ICP孕妇为观察组,同时抽选50例正常孕妇作为对照组。比较两组各检测指标差异及分析其相关性。结果:1观察组新生儿窒息、呼吸窘迫等肺损伤病症发生率44%、20%显著多于对照组14%、0%,差异有统计学意义(P<0.05);2观察组母体血清及新生儿脐带血清TBA明显高于对照组,差异有统计学意义(P<0.05),观察组新生儿脐带血清TBA与母体血清TBA呈正相关(P<0.05);3观察组胎儿肺主动脉末期流速(S/D)、阻力指数(RI)、搏动指数(PI)均高于对照组,差异有统计学意义(P<0.05),而板层小体(LB)、肺面积/体重比低于对照组,差异有统计学意义(P<0.05);4观察组胎儿动脉血氧饱和度(SO2)、氧分压(PO2)、酸碱度(PH)低于对照组,差异有统计学意义(P<0.05);5观察组新生儿脐带血清TBA与胎儿肺主动脉S/D、RI呈正相关,与肺面积/体重比、LB呈负相关(P<0.05);胎儿肺面积/体重比、LB与PO2、PH呈正相关,与二氧化碳分压(PCO2)呈负相关;而RI、S/D与PO2、PH呈负相关,与PCO2呈正相关。结论:ICP产妇血清TBA及新生儿脐带血清TBA浓度升高,ICP产妇胎儿存在肺损伤与TBA升高有关,胎儿肺主动脉RI、肺面积/体重比对于早期发现肺损伤具有一定临床意义。
Objective: To investigate the relationship between fetal lung injury and serum total bile acid (TBA) in pregnant women with intrahepatic cholestasis of pregnancy (ICP). Methods: Fifty pregnant women undergoing cesarean delivery in this hospital were randomly selected as the observation group and 50 normal pregnant women as the control group. The differences between the two groups were compared and their correlations were analyzed. Results: 1 The incidence of neonatal asphyxia, respiratory distress and other lung injury in the observation group was 44%, 20% significantly higher than that in the control group (14%, 0%), the difference was statistically significant (P <0.05); 2 The observation group maternal serum and The neonatal cord blood serum TBA was significantly higher than the control group, the difference was statistically significant (P <0.05), the observation group neonatal cord serum TBA and maternal serum TBA was positively correlated (P <0.05); 3 observation group fetal pulmonary end-stage flow velocity (S / D), resistance index (RI) and pulsatility index (PI) of the control group were significantly higher than those of the control group (P <0.05) (P <0.05) .4 In the observation group, arterial oxygen saturation (SO2), partial pressure of oxygen (PO2) and pH were lower than those in the control group (P <0.05), and the difference was statistically significant (P <0.05). (5) The neonatal cord blood serum TBA in the observation group was positively correlated with S / D and RI of fetal pulmonary aorta, negatively correlated with lung area / body weight ratio and LB (P <0.05), fetal lung area / body weight ratio Positive correlation with PO2, PH, negatively correlated with the partial pressure of carbon dioxide (PCO2); while RI, S / D was negatively correlated with PO2, PH and positively correlated with PCO2. Conclusion: ICP maternal serum TBA and neonatal cord serum TBA levels increased, ICP maternal fetal lung injury associated with elevated TBA, fetal pulmonary aortic RI, lung area / body weight ratio for the early detection of lung injury has some clinical significance.