伴有和不伴有全身炎症反应综合征的早产胎儿的血液酸碱度和气体情况
Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome.
作者信息
Romero Roberto, Soto Eleazar, Berry Stanley M, Hassan Sonia S, Kusanovic Juan Pedro, Yoon Bo Hyun, Edwin Samuel, Mazor Moshe, Chaiworapongsa Tinnakorn
机构信息
Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women's Hospital, Detroit, MI 48201, USA.
出版信息
J Matern Fetal Neonatal Med. 2012 Jul;25(7):1160-70. doi: 10.3109/14767058.2011.629247. Epub 2011 Dec 20.
OBJECTIVE
Fetal hypoxemia has been proposed to be one of the mechanisms of preterm labor (PTL) and delivery. This may have clinical implications since it may alter: (i) the method/frequency of fetal surveillance and (ii) the indications and duration of tocolysis to an already compromised fetus. The aim of this study was to examine whether there is a difference in the fetal blood gas analysis [pH, PaO(2) and base excess (BE)] and in the prevalence of fetal acidemia and hypoxia between: (i) patients in PTL who delivered within 72 hours vs. those who delivered more than 72 hours after cordocentesis and (ii) patients with fetal inflammatory response syndrome (FIRS) vs. those without this condition.
STUDY DESIGN
Patients admitted with PTL underwent amniocentesis and cordocentesis. Ninety women with singleton pregnancies and PTL were classified according to (i) those who delivered within 72 hours (n = 30) and after 72 hours of the cordocentesis (n = 60) and (ii) with and without FIRS. FIRS was defined as a fetal plasma concentration of IL-6 > 11 pg/mL. Fetal blood gases were determined. Acidemia and hypoxemia were defined as fetal pH and PaO(2) below the 5th percentile for gestational age, respectively. For comparisons between the two study groups, ΔpH and ΔPaO(2) were calculated by adjusting for gestational age (Δ = observed value - mean for gestational age). Non-parametric statistics were employed.
RESULTS
No differences in the median Δ pH (-0.026 vs. -0.016), ΔPaO(2) (0.25 mmHg vs. 5.9 mmHg) or BE (-2.4 vs. -2.6 mEq/L) were found between patients with PTL who delivered within 72 hours and those who delivered 72 hours after the cordocentesis (p > 0.05 for all comparisons). Fetal plasma IL-6 concentration was determined in 63% (57/90) of fetuses and the prevalence of FIRS was 28% (16/57). There was no difference in fetal pH, PaO(2) and BE between fetuses with and without FIRS (p > 0.05 for all comparisons). Moreover, there was no difference in the rate of fetal acidemia between fetuses with and without FIRS (6.3 vs. 9.8%; p > 0.05) and fetal hypoxia between fetuses with or without FIRS (12.5 vs. 19.5%; p > 0.05).
CONCLUSIONS
Our data do not support a role for acute fetal hypoxemia and metabolic acidemia in the etiology of PTL and delivery.
目的
胎儿低氧血症被认为是早产（PTL）及分娩的机制之一。这可能具有临床意义，因为它可能改变：（i）胎儿监测的方法/频率，以及（ii）对已处于危险中的胎儿进行宫缩抑制的指征和持续时间。本研究的目的是检查在以下两组之间胎儿血气分析[pH、动脉血氧分压（PaO₂）和碱剩余（BE）]以及胎儿酸血症和低氧血症的患病率是否存在差异：（i）PTL患者中在脐带穿刺术后72小时内分娩者与脐带穿刺术后72小时以上分娩者，以及（ii）胎儿炎症反应综合征（FIRS）患者与无此病症的患者。
研究设计
因PTL入院的患者接受了羊膜腔穿刺术和脐带穿刺术。90名单胎妊娠且患有PTL的女性根据以下情况进行分类：（i）在脐带穿刺术后72小时内分娩者（n = 30）和72小时后分娩者（n = 60），以及（ii）有和无FIRS者。FIRS定义为胎儿血浆白细胞介素-6（IL-6）浓度> 11 pg/mL。测定胎儿血气。酸血症和低氧血症分别定义为胎儿pH和PaO₂低于胎龄的第5百分位数。为比较两个研究组，通过校正胎龄计算ΔpH和ΔPaO₂（Δ = 观察值 - 胎龄均值）。采用非参数统计。
结果
在脐带穿刺术后72小时内分娩的PTL患者与脐带穿刺术后72小时后分娩的患者之间，未发现中位ΔpH（-0.026对-0.016）、ΔPaO₂（0.25 mmHg对5.9 mmHg）或BE（-2.4对-2.6 mEq/L）存在差异（所有比较p>0.05）。63%（57/90）的胎儿测定了胎儿血浆IL-6浓度，FIRS的患病率为28%（16/57）。有和无FIRS的胎儿之间，胎儿pH、PaO₂和BE无差异（所有比较p>0.05）。此外，有和无FIRS的胎儿之间，胎儿酸血症发生率（6.3%对9.8%；p>0.05）和胎儿低氧血症发生率（12.5%对19.5%；p>0.05）无差异。
结论
我们的数据不支持急性胎儿低氧血症和代谢性酸血症在PTL及分娩病因学中的作用。
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