胎儿头皮血乳酸测定监测胎儿宫内缺氧

Detection of Lactic Acid from Fetal Scalp Blood for Monitoring Fetal Distress

目的:探讨微量胎儿头皮血乳酸测定监测胎儿宫内缺氧的临床意义。方法:对261例产妇进行全产程连续电子胎心监护,第二产程分娩前30min取5μl胎儿头皮血测定乳酸水平,结合新生儿1min Apgar评分和羊水性状进行分组,评估胎儿头皮血乳酸值与胎儿宫内缺氧的关系。结果:①窒息组胎儿头皮血乳酸值为(51.8±20.7)mmol/L,明显高于正常组的(2.74±l.23)mmol/L(P<0.01)。②羊水正常组和轻度粪染组胎儿头皮血乳酸值分别为(2.65±1.16)mmol/L和(2.94±1.30)mmol/L,明显低于羊水高度粪染组(3.49±1.93)mmol/L(P<0.01和P<0.05)。③产程的长短不影响胎儿头皮血乳酸值检测结果(F=1.766, P>0.05)。结论:微量胎儿头皮血乳酸测定可以直接反映胎儿宫内缺氧程度和评估胎儿预后,是一种简便、安全的检测方法。

Objective:To investigate the significance of detecting lactic acid of fetal scalp blood for monitoring fetal distress. Methods: The central electronic monitoring system was performed in 261 pregnant women during labor from March to August of 2002. The 5 μl of fetal scalp blood concentrations of lactic acid were measured within 30 minutes before birth in second duration of labor from 261 fetuses.The relationship between the lactic acid concentrations of fetal scalp blood and fetal asphyxia was evaluated,and according to neonatal Apgar scores at 1 minute, amniotic fluid ,the time of second duration of labor, 261 cases were divided into several groups. Results: Lactic acid levels of fetal scalp blood in neonate asphyxia group were significantly higher (5.18±2.07)mmol/L than those in the normal newborn group (2.74±1.23)mmol/L,P<0.01. Mean levels of lactic acid in fetal scalp blood in normal amniotic fluid group and in slight meconiun liquor group were lower than those in severe meconiun liquor group[ (2.65±1.16)mmol/L and(2.94±1.30)mmol/L vs. (3.49±1.93)mmol/L,P<0.01 and P<0.05 res-pertively]. However, there was no significant relationship between the fetal scalp blood concentrations of lactic acid and time of second duration of labor.Conclusion: Our data suggest that determination of the lactic acid concentration in fetal scalp blood is a simple, safe and sensitive diagnostic marker for monitoring the condition of fetus.