Riehn A, Riehn F, Wiedemann B, Distler W
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden.
Z Geburtshilfe Neonatol. 1995 May-Jun;199(3):103-6.
The aim of the study was to evaluate the effects of maternal pethidine administration on fetal outcome and incidence of neonatal respiratory distress in deliveries with meconium stained amniotic fluid (MAF).
Between 1989 and 1992, 849 live infants had MAF. For pain relief during labor 214 women received pethidine 50-150 mg i.m. The control group included 401 infants with MAF, who were not exposed to sedatives, analgesics, and anesthetics during labor. Fetal cord pH, Apgar 1 min (A1), Apgar 5 min (A5), and incidence of respiratory distress were compared retrospectively between the groups. Statistics and calculations were done by means of uni- and multivariate analyses.
The presence of thickened MAF increased significantly the risk of low A1, low A5, low arterial cord pH, and the incidence of respiratory distress (p = 0.003, = 0.0003, = 0.016, = 0.000). Infants with thickened MAF, low A1, and low fetal cord pH proved to have an exceedingly high risk of respiratory distress. The application of pethidine (0 mg, 50 mg, 100-150 mg) does not discriminate the variables as arterial cord pH, A1, A5, and the incidence of respiratory distress significantly. However the medium cord pH values of infants without pethidine (7.27, s = 0.075) and with 100-150 mg pethidine (7.25, s = 0.078) were significantly different (p = 0.0006). The incidence of arterial pH, 7.10 did not differ significantly in cases with different pethidine doses.
Thickened MAF is an obstetric hazard with small but significantly increased risks for poor fetal outcome and neonatal respiratory distress. This study failed to identify additional neonatal risks engendered by use of pethidine in cases of MAF.
本研究旨在评估在羊水胎粪污染（MAF）的分娩中，产妇使用哌替啶对胎儿结局及新生儿呼吸窘迫发生率的影响。
1989年至1992年间，849例活产婴儿存在羊水胎粪污染。为缓解分娩时的疼痛，214名妇女接受了50 - 150毫克的肌肉注射哌替啶。对照组包括401例羊水胎粪污染的婴儿，他们在分娩期间未接触镇静剂、镇痛药和麻醉剂。对两组的胎儿脐动脉血pH值、1分钟阿氏评分（A1）、5分钟阿氏评分（A5）以及呼吸窘迫发生率进行回顾性比较。统计和计算通过单因素和多因素分析进行。
浓稠的羊水胎粪污染显著增加了低A1、低A5、低脐动脉血pH值以及呼吸窘迫发生率的风险（p = 0.003，= 0.0003，= 0.016，= 0.000）。浓稠羊水胎粪污染、低A1以及低胎儿脐动脉血pH值的婴儿被证明有极高的呼吸窘迫风险。哌替啶（0毫克、50毫克、100 - 150毫克）的使用并未显著区分脐动脉血pH值、A1、A5以及呼吸窘迫发生率等变量。然而，未使用哌替啶婴儿的脐动脉血pH值中位数（7.27，s = 0.075）与使用100 - 150毫克哌替啶婴儿的脐动脉血pH值中位数（7.25，s = 0.078）有显著差异（p = 0.0006）。不同哌替啶剂量情况下，动脉血pH值低于7.10的发生率无显著差异。
浓稠的羊水胎粪污染是一种产科危险因素，虽风险较小，但胎儿不良结局及新生儿呼吸窘迫的风险显著增加。本研究未能确定在羊水胎粪污染情况下使用哌替啶会产生其他新生儿风险。
