产时不同类型胎儿酸血症与胎心监护图形的关系

Different Types of Acidemia at Birth, Fetal Heart Rate Patterns and Infants Outcome at four Years of Age

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２９８１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。

Objective To study the relations between different types of acidemia in umbilical artery at birth, fetal heart rate patter`ns (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 development. Conclusions Late deceleration may be an indicator of pure metabolic acidemia and complicated variable deceleration be an indicator of mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute after birth. The relation between acidemia at birth and deficit in speech/language development should be further evaluated.