脐血生化指标的变化及其与胎儿窘迫的关系

Relationship between Changes of Umbilical Blood Biochemical Indexes and Fetal Distress

目的探讨脐血乳酸(LD)、pH、血糖(BS)、总胆红素(BIL)、电解质、渗透压(OP)等变化与胎儿窘迫的关系。方法胎儿宫内窘迫35例为窘迫组,正常妊娠40例为对照组。窘迫组中新生儿出生无窒息为窘迫Ⅰ组,有窒息为窘迫Ⅱ组。分别测定脐血乳酸、pH、BS、BIL、Na+、K+、Ca2+和OP。结果1.窘迫组新生儿窒息发生率(29.03%)显著高于对照组(2.50%);2. 窘迫Ⅰ组LD(2.83±0_83)mmol/L和窘迫Ⅱ组(3.44±0.45)mmol/L,均显著高于对照组(2.45±0.63)mmol/L。窘迫Ⅰ组LD与窘迫Ⅱ组比较,亦有显著性差异;3.各组pH、BS、BIL、Na+、K+、Ca2+、OP水平均无显著差异(P均>0.05),但窘迫组高血糖发生率(8.6%)显著高于对照组;4.窘迫Ⅰ组、Ⅱ组脐血LD水平与pH均呈显著负相关。结论脐血LD水平有助于判断宫内窘迫的发生及预后。

Objective To study the changes of umbilical blood lactate, pH, blood sugar（BS）, bilirubin, electrolyte,osmotic pressure （OP） in the newhoms with fetal distress. Methods Thirty- five newhorns with fetal distruess （distress group） and 40 healthy newhorns （control group） were studied. Distress group were divided into distress group Ⅰ and distress group Ⅱ respectively, based on without or with neonatal asphyxia. Concentration of umbilical blood lactate was determined with enzyme method, pH, BS, ,serum total biliruhin （BIL）, serum electrolyte （Na^＋ , K^＋ , Ca^2＋ ） and OP were analyzed respectively. Results 1. The difference of incidence of newhom asphyxia between distress groups （29.03%） and control group （2.50%） was statistically significant. 2. Compared with the controls and distress group Ⅰ, the umbilical blood lactate concentration significantly increased in distress group Ⅱ （P 〈 0.05 ）. Lactate concentration was significantly increased in distress group Ⅰ than that in control group （P 〈 0.05 ）. 3. There were no significant differences in 3 groups in umbilical blood pH, BS, BI L, Na^＋ , K ^＋ , Ca^2＋ 4 and OP （ P 〉 0.05 ）. The incidence of hyperglycemia was significantly elevated in distress groups than that in the control group. 4. Lactate concentration in distress Ⅰ and distress Ⅱ group showed negative correlation with pH. Conclusion The concentration of umbilical blood lactate can provide the proof for diagnosis and prognosis of fetal distress.