产程中持续内监护下行羊膜腔输液及羊水置换治疗胎儿窘迫

Significance of Amnioinfusion and Amniotic Fluid Exchange under Continuous Internal Fetal Heart Rate Monitoring for Management of Fetal Distress during Labor

目的 探讨产程中持续内监护下行羊膜腔输液及羊水置换 ,对治疗胎儿窘迫的意义。方法 对产程中出现频发可变减速 (variabledeceleration ,VD)合并羊水胎粪污染者 13 6例 ,随机分为观察组与对照组各 68例。观察组在持续内监护下行羊膜腔输液或羊水置换。对照组给予吸氧、改变体位、静脉输液等治疗。结果 观察组经羊膜腔输液 5 0 0～ 10 0 0ml,VD波消失或明显改善者占 91.2 % ,同时对观察组中 4 8例羊水Ⅱ度以上粪染者行羊水置换 ,其中 3 9例羊水转为清亮或Ⅰ度粪染。对照组经治疗VD改善者占 19.4 % ,明显低于观察组 ,两组比较 ,差异有极显著性 (P <0 .0 1)。观察组剖宫产率 14 .7% ,新生儿窒息率 7.4 %。对照组剖宫产率 4 7.1% ,新生儿窒息率 4 8.5 % ,明显高于观察组(P <0 .0 1,P <0 .0 1)。对照组新生儿患胎粪吸入性肺炎 13例 ,胎粪吸入综合征 8例 ,新生儿死亡 5例 ,而观察组无一例发生。产褥病率两组比较 ,差异无显著性 (P >0 .0 5 )。结论 羊膜腔输液及羊水置换 ,是治疗产程中胎儿窘迫的有效方法之一。

Objective To discuss the significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate (FHR) monitoring for management of fetal distress during labor. Methods 136 cases with frequent variable deceleration (VD) and meconium stained amniotic fluid during labor were divided into two groups: the study group (68 cases) and the control group (68 cases). The former were treated by amnioinfusion and amniotic fluid exchange, while oxygen inhalation, change of body position, and intravenous infusion for the control group. Results In the study group, VD disappeared or relieved in 62 cases obviously, and the efficacy rate reached 91.2% (62/68). 48 cases with Ⅱ degree meconium stained amniotic fluid were treated by amniotic fluid exchange, amniotic fluid became clear or turned to Ⅰ degree stained in 39 cases. In the control group, VD relieved in 20 cases, the efficacy rate was 19.4%, significantly lower than that of the study group ( P <0.01). In the study group, cesarean section rate was 14.7% neonatel asphyxia 7.4% while they were 47.1% and 48.5% in the control group respectively ( P <0.01; P <0.01). Neonatel pneumonia caused by meconium aspiration occurred in 13 cases, meconium aspiration syndrome (MAS) 8 cases, with 5 newborns died in the control group, while there was no neonatel death in the study group. There was no significant difference on puerperal morbidity between the 2 groups ( P >0.05). Conclusions Amnioinfusion and AF exchange during labor are one of the effective treatment methods for fetal distress and prevention for MAS.