经腹羊膜腔输液治疗小于34孕周羊水过少的疗效观察

Clinical observation of transabdominal amnioinfusion in treating oligohydramnios within 34 weeks gestation:A report of 32 cases.

目的：探讨产前经腹羊膜腔输液在临床应用的可行性。方法：以３２ 例（早破膜及未破膜者）＜ ３４ 孕周羊水过少的患者作为研究对象，在Ｂ超引导下，经腹壁行羊膜腔穿刺，留置导管，向羊膜腔内输３７℃复方氯化钠溶液３００～５００ｍ ｌ／ｄ，滴速２ｍ ｌ／ｍ ｉｎ，羊水指数＞ ８ｃｍ 为停止输液指标。辅以抑制宫缩及促胎肺成熟、防治感染等综合治疗，观察延长孕龄的时间及母婴预后。取３２例未开展本研究之前孕周相同的羊水过少患者作为对照。结果：研究组孕龄延长最短３ｄ，最长３８ｄ。剖宫产率、产后出血率及产褥病率均无明显增加。研究组早产儿Ａｐｇａｒ评分１、５ｍ ｉｎ 均高于对照组（Ｐ＜ ０．０５，Ｐ＜ ０．０１），研究组围产儿存活率明显高于对照组（Ｐ＜ ０．０１）。结论：产前经腹羊膜腔内输液是治疗＜ ３４孕周羊水过少的简便、有效措施之一。

Objective:To evaluate the feasibility of prenatal amnioinfusion via abdominal route in clinical practice.Methods:32 cases of oligohydramnios within 34 week's gestation(24 cases with premature repture of membranes and 8 cases without rupture of membranes)underwent intrauterine amnioinfusion with 37℃ Ringer solution under B ultrasound guiding and through a sustained anesthesia catheter.The Ringer solution was infused 300 500 ml/d at a rate of 2 ml/min.When amniotic fluid index increased over 8 cm,the infusion stopped.Inhibition of uterine contraction,fetal lung maturation and infection prevention were carried out.The prolonged gestation and outcome of mother and fetuses were observed.32 cases of oligohydramnios at the same corresponding gestation age without amnioinfusion were taken as controls.Results: The gestational ages were prolonged 3 38 days in study group.The 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,5 min and perinatal survival were significantly higher than that of control group( P <0.05, P <0.01 and P <0.01).Conclusion:Prenatal transabdominal amnioinfusion is effective and convenient in treating oligohydramnios within 34 week's gestation.