经腹羊膜腔内灌注治疗妊娠晚期羊水过少的临床观察

Clinical observation of transabdominal amnioinfusion in treating oligohydramnios in third trimester of pregnancy

目的 :探讨妊娠晚期经腹羊膜腔内灌注在临床应用的可行性。方法 :选择妊娠 2 8～ 36周羊水过少的 30例患者 (早破膜18例及未破膜 12例 ) ,在B超引导下 ,经腹壁行羊膜腔穿刺 ,留置导管每天向羊膜腔内灌注 37℃复方氯化钠溶液 30 0～50 0ml,滴速 3ml/min ,羊水指数 >8cm停止灌注 ,同时辅以抑制宫缩、促胎肺成熟和防治感染等综合治疗 ,观察延长孕龄的时间及母婴预后。取 2 8例未开展本研究前孕周相同的羊水过少患者作对照。结果 :研究组孕龄延长 5～ 2 8天 ,剖宫产率、产后出血率及产褥病率均无明显增加 (P >0 .0 5) ;新生儿Apgar评分高于对照组 (P <0 .0 5) ;出生体重也明显高于对照组 (P <0 .0 5)。结论 :经腹羊膜腔内灌注是治疗妊娠晚期羊水过少的简便、有效的措施之一。

Objective: To evaluate the feasibility of prenatal amnioinfusion viaabdominal route in clinical practice. Methods: Under B-ultrasound guiding, 30 case of oligohydramnios within 28～36 week's gestation(18 case with premature rupture of membranes and 12 cases without rupture of membranes) underwent intrauterine amnioinfusion with 300～500ml 37 C Ringer solution per day at 3ml/min through a sustained anesthesia catheter, the infusion was stopped when the amnioticfluid index was over 8cm. Inhibition of uterine contraction, fetal lung maturation and infection prevention were also carried out at the same time as auxiliary treatment. The prolonged gestation and outcome of mother and fetuses were observed. 28 case of oligohydramnios at the same corresponding gestation age were taken as controls.Results: In the study group, the gestational ages were prolonged 5～28 days; incidences of cesarean sections, postpartum haemorrhage, and puerperal morbidity were not different from those in control group (P>0.05); The Apgar scores at 1 min and newborn avoirdupois were significantly higher than those of the control group(P<0.05). Conclusions: Transabdominal amnioinfusion is effective and convenient in treating oligohydramnios within 30～35 week's gestation.