宫内复苏术对足月胎儿窘迫脐血指标的影响及新生儿神经功能的评估

Effect of intrauterine resuscitation on umbilical cord blood parameters of full-term fetal distress and evaluation of neonatal nerve function

目的：研究宫内复苏术对足月胎儿窘迫脐血指标及新生儿神经功能的影响。方法：选择2008年2月~2010年10月120例在东莞市中堂医院妇产科分娩且产程中发生胎儿窘迫的产妇74例进行研究,随机分为两组,观察组接受宫内复苏术,对照组接受常规治疗,比较两组患者的脐动脉血气指标和细胞因子含量、新生儿血清中神经损伤分子含量以及新生儿窒息情况、神经功能。结果：观察组脐带血的pH值、PO2、HCO3-高于对照组,PCO2、BE绝对值低于对照组,均P〈0.05;观察组患者的脐动脉血和脐静脉血内IL-6、IL-8、IFN-γ的含量均显著低于对照组（均P〈0.05）;出生后1d、3d、5d、7d时,观察组新生儿的血清NSE、S-100蛋白含量显著低于对照组（均P〈0.05）;新生儿的窒息情况和神经功能均优于对照组。结论：宫内复苏术能够改善胎儿宫内缺氧状况、减轻酸中毒,同时减轻新生儿神经功能损伤、预防新生儿窒息,是治疗足月胎儿窘迫的理想方法。

Objective： To study the effect of intrauterine resuscitation on umbilical cord blood parameters of full-term fetal distress and neonatal nerve function. Methods.. A total of 74 cases of women who gave birth in Gynecology and Obstetrics Department of our hospital and had fetal distress during labor from February 2008 to October 2010 were selected for study and randomly divided into two groups, observation group received intrauterine resuscitation, control group received conventional treatment, and then contents of umbilical arterial blood gas parameters and cytokines of two groups of patients, contents of se- rum nerve injury molecules of neonates as well as neonatal asphyxia condition and nerve function were compared. Results： pH value, PO2 and HCO3- in umbilical cord blood of observation group were higher than control group. PCO2 and BE absolute value were lower than control group. IL-6, IL-8 and IFN-7 contents in umbilical arterial blood and umbilical venous blood of observation group were significantly lower than control group. Serum NSE and 8-100 protein contents of observation group were significantly lower than control group when tested （1 d, 3 d, 5 d and 7 d after birth）. Additionally, Neonatal asphyxia condition and nerve function of the observation group were better than control group. Conclusion： Intrauterine resuscitation can improve intrauterine fetal anoxia and reduce acidosis while reduce neonatal nerve function injury and prevent neonatal asphyxia, and it is an ideal method to treat full-term fetal distress.