羊膜腔内输液及其压力测定治疗胎膜未破羊水过少的临床意义

The pressure of amniotic cavity during pregnancy and treatment of unruptured oligohydramnios with antepartum amnioinfusion

目的测定妊娠各期羊膜腔内压力的正常值、异常值，并探讨羊膜腔内输液对治疗胎膜未破羊水过少的临床意义。方法自行设计经腹壁穿刺的羊膜腔内压力监测和治疗三通管道装置。测定７１例妊娠各期孕妇羊膜腔内压力和３９例羊水过少及羊水过多孕妇的羊膜腔内压力。对３３例胎膜未破羊水过少者在羊膜腔内压力监测下行宫腔内输注药液治疗，与６４例行静脉滴注治疗者进行对比分析。结果正常妊娠各期羊膜腔内压力为１６９±０２３ｋＰａ，羊水过多者为３２±０３ｋＰａ，羊水过少者为１１±０３ｋＰａ，（Ｐ＜００１～０００１）。胎膜未破羊水过少病例行羊膜腔内输液治疗后，羊水指数增加５０±１８ｃｍ，羊膜腔内压力升高０１８±０２１ｋＰａ，维持６５±２６天，阴道分娩率达８７９％（对照组１２１％，两者比较Ｐ＜０００１），未发生羊膜腔内输液并发症。结论正常妊娠各期羊膜腔内压力为一相对稳定值，但随羊水过多而升高，过少而下降。在同步监测羊膜腔内压力的情况下，羊膜腔内输注药液治疗胎膜未破羊水过少，能明显地提高孕妇阴道分娩率，降低剖宫产率。

Objectives To measure the pressure of the amniotic cavity during pregnancy and to study the effects of antepartum amnioinfusion on oligohydramnios with intact membranes. Method We used an improved three way switch apparatus to measure 110 women during pregnancy, and treated 97 oligohydramnios with antepartum amnioinfusion or intravenous infusion as controls. Results The pressure of the amniotic cavity was 1.69±0 23 kPa, which was close to the normal value in pregnancy. In oligohydramnios, it was 1.1±0.3 kPa, and in polyhydramnios 3 2±0 3 kPa( P <0 01～0 001). When 300 ml fluid was amnioinfused,the amniotic fluid index(AFI) increased by 5.0±1.8 cm, the pressure of amniotic cavity increased by 0.18±0.2/kPa and the incidence of vaginal delivery was 87.9%, whereas that of the control group was 12.1%. There were no fetal distress, asphyxia neonatorum, amnionitis or ruptured membrane. Conclusions The pressure of the amniotic cavity during normal pregnancy was stable, but changed with AFI.Antepartum amnioinfusion for unruptured oligohydramnios resulted in a marked increase in incidence of vaginal delivery, a decreased ratio of cesarean section and a reduction of perinatal morbidity. These differences are highly significant.