羊膜腔输注药物治疗羊水过少并发胎儿窘迫的临床效果观察

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。

Significance of infusion of sodium bicarbonate in amniotic cavity under continuous internal fetal heart rate monitoring for management of fetal distress during labor

OBJECTIVE: To investigate the effect of infusion of sodium bicarbonate in amniotic cavity and exchange of amniotic fluid for fetus with distress and acidosis. METHODS: The patients included 40 cases of oligohydramnios with mild and serious abnormality of fetal heart rate and amniotic fluid contamination of degree II or more during the labor. The 40 cases had exchange of amniotic fluid with infusion under continuous monitoring. Twenty of them had infusion with 5% sodium bicarbonate into amniotic cavity; the other 20 cases received 5% sodium bicarbonate intravenous in fusion. After the labor all the patients had test of arterial blood gas in umbilical cord and the fetuses were evaluated with Apgar score. RESULTS: (1) the effective rate was 88% in the group of infusion into amniotic cavity and 85% in the group of exchange of amniotic fluid. (2) The arterial blood pH, PO(2), HCO(3)(-), ABE, SBE in the group of amniotic cavity infusion with 5% sodium bicarbonate were all higher than group of IV infusion, however PCO(2) was significantly lower than the group of IV (P < 0.05). CONCLUSION: Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis.