羊膜腔输液治疗在产时应用的临床分析

目的 :分析羊膜腔输液 (amnioinfusion,AI)治疗产时羊水过少、胎膜早破和胎粪性羊水的临床意义。方法 :选择产程中发生胎心异常合并羊水过少、胎膜早破和羊水胎粪污染的孕产妇 1 0 1例 ,随机分为治疗组 51例 ,对照组 50例。治疗组在胎心监护下行羊膜腔输液或羊水置换 ;对照组给予吸氧 ,改变体位 ,静滴 5% Na HCO3等治疗。结果 :治疗组经羊膜腔输液 50 0～ 1 0 0 0 ml,胎心可变减速 (variable deceleration,VD)和长时减速 (period long deceleration,PL D)消失或明显改善 44例 ,有效率占 86 .3% ,明显高于对照组 (2 2 % ) ,两组比较差异有显著性 (P<0 .0 1 )。治疗组 1 9例胎粪性羊水行羊水置换 ,有 1 7例羊水转为清亮或 度混浊。治疗组产程时间比对照组缩短 ,治疗组和对照组剖宫产率分别为 1 3.7%和 34.0 % ,新生儿窒息率分别为 3.9%和 42 .0 % ;对照组胎粪吸入性肺炎 9例 ,新生儿死亡 3例 ,治疗组仅一例发生胎粪吸入性肺炎 ,无新生儿死亡。产褥病率两组比较 ,差异无显著性 (P>0 .0 5)。结论 :羊膜腔输液是治疗产时羊水过少、胎膜早破、胎粪性羊水的有效方法

Clinical analysis of the amnioinfusion treatment during labor

Objective: To analysis the clinical significance of amnioinfusion(AI) treatment for oligohydramnion, premature rupture of fetal membranes and meconium stained amniotic fluid during labor. Methods: One hundred and one cases with abnormal fetal heart rate(FRH) and oligohydramnion, premature rupture of fetal membranes or meconium stained amniotic fluid during labor were divided into two groups randomly: the treatment group(51 cases) and control group(50 cases). The former were treated with AI or amniotic fluid exchange under FRH monitoring, the latter were treated with oxygen inhalation, change of body position, and intravenous infusion. Results: In the treatment group, variable deceleration(VD) and period long deceleration(PLD) disappeared or relieved in 44 cases obviously, with an response rate of 86.3%. Nineteen cases with meconium stained amniotic fluid were treated with amniotic fluid exchange, amniotic became clear or turned toⅠdegree stained in 17 cases. In the control group, abnormal FRH relieved in 11 cases with an response rate of 22%, which was significantly lower than that in treatment group ( P <0.01). In the treatment group, the labor time was shorter, cesarean section rate was 13.7% neonatal asphyxia 3.9% , significantly lower than 34.0%, 42.0% in the control group respectively. In the control group, neonatal pneumonia caused meconium aspiration occurred in 9 cases, neonatal death 3 cases, while only one case pneumonia, no death in the treatment group. There was no significant difference in the puerperant morbidity between the two group (P> 0.05). Conclusion: AI is an effective treatment for oligohydramnions, premature rupture of fetal membranes and meconium stained amniotic fluid during labor.