产时不同类型胎儿酸血症与胎心监护图形的关系.docVIP

产时不同类型胎儿酸血症与胎心监护图形的关系 ???? 产时不同类型胎儿酸血症与胎心监护图形的关系 ???? 中华妇产科杂志 1998年第8期第0卷 论著 ???? 作者：吴连方　Thorngren-Jerneck K　 Ingemasson I ???? 单位：100006 北京妇产医院(吴连方)；LUND University Hospital (Thorngren-Jerneck K, Ingemasson I) ???? 关键词：酸中毒；心率；胎儿；心分娩力描记法 ???? 　　 　　【摘要】　目的　研究产时脐动脉血显示的不同类型酸血症与产时胎心监护图形变化的关系及产后4年随诊的结果。方法　采用回顾性病例对照研究方法，选择对象为1991年单胎、足月分娩的2 981例新生儿，产程中定时胎心监护，分娩时测定脐动脉血气。生后4年进行儿童随诊。结果　纯代谢性酸血症47例(代酸组)，混合性酸血症67例(混酸组)，该两组在第一产程末，胎心率评分＜6和6～7分者发生率显著高于对照组。减速图形特点显示晚期减速与纯代谢性酸血症有关，而异常可变减速与混合性酸血症有关。两组产后1分钟Apgar评分＜7分者也明显高于对照组。儿童4岁时随诊其发育、运动和语言能力显示：代酸组及混酸组和对照组比较差异无显著性，只在混酸组语言表达迟钝的例数略多。结论　晚期减速可能是纯代谢性酸血症的一个表现，而异常可变减速可能是混合性酸血症的一个表现。两者均与1分钟Apgar评分低分的发生有密切关系。产时酸血症和以后的语言发育缺陷间关系需进一步估价。 ???? 　　Different Types of Acidemia at Birth, Fetal Heart Rate Patterns and Infants Outcome at four Years of Age　Wu Lianfang, Thorngren-Jerneck K, Ingemasson I.　Beijing Obstetric and Gynecology Hospital, Beijing 100006 ???? 　　【Abstract】　Objective　To study the relations between different types of acidemia in umbilical artery at birth, fetal heart rate patterns (FHR) during laobr and infant long-term outcome.Methods　2 981 cases with singleton term pregnancy were selected for retrospective case-control study. Fetal monitoring was performed periodically during labor and umbilical blood gas was analyzed at birth and the infants outcome was followed up at age 4. Results　There were 47 infants with pure metabolic acidemia and 67 infants with mixed acidemia. The incidence of FHR score ＜6 and 6-7 at the end of first stage was significantly higher in the two study groups than that in the control group. Late deceleration was associated with pure metabolic acidemia and complicated variable deceleration with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute after birth. Developmental screening at age 4 showed no significant differences between the two study groups and the control groups. In the mixed acidemia group there were slightly more infants had deficits in speech/language