妊娠肝内胆汁淤积症胎儿监护和肝功能联合检测的临床价值

目的探讨对妊娠肝内胆汁淤积症(ICP)孕妇进行胎儿监护和分度诊断的临床价值。方法对125例ICP 孕妇进行无负荷试验(NST),对其中56例进行宫缩应力试验(CST)或催产素激惹试验(OCT),125例进行超声脐动脉血流分析。并根据血清胆红素转氨酶等肝功能检测将125例ICP孕妇分为轻度和重度。结果 OCT和超声脐血流分析结果异常者的围产儿预后不良的发生率分别为54．17％和51．92％,明显高于正常者的21．88％和28．77％,差异有统计学意义 (P<0．05和P<0．05)。NST正常者和异常者的围产儿预后不良发生率无明显差异。ICP重型患者的胎儿宫内窘迫率、新生儿窒息率、早产率、胎儿电子监测异常率及脐血流异常率高于轻型惠者。结论 OCT和超声脐动脉血流分析对了解ICP孕妇胎盘功能和预测围产儿预后具有较高的临床价值;NST和超声脐动脉血流分析具有操作简便、价格低廉、对母婴无任何创伤、重复性强等优点,可作为了解ICP孕妇胎儿宫内安危的首选监护项目;肝功能检测划分ICP轻重型并结合胎儿监护有助于提高围产儿预后。

Clinical value of fetal electrical monitoring and liver function test in ICP

Objective: To study the clinical value of fetal monitoring and grading in ICP. Methods : 125 cases were examined by the fetal monitoring and ultrasonic umbilical artery flow analysis; these cases were graded into mild ICP and severe ICP according to liver function test. Results: There is a significance difference between normal and abnormal groups of the poor perinatal prognosis in oxy tocin challenge test (OCT) and ultrasonic umbilical artery flow analysis ( P < 0. 05 ). There is no difference between normal and abnormal groups of the poor perinatal prognosis in nonstress test (NST) . The incidences of poor perinatal prognosis in severe ICP groups were higher than those in mild ICP groups. Conclusion: OCT and ultrasonic umbilical artery flow analysis have the higher clinical value to detect the poor placental function and to forecell the perinatal prognosis in ICP. Grading of ICP based on liver function test may improve perinatal prognosis.