第二产程中产妇用力对胎儿脑氧合及血容量的影响。
The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour.
作者信息
Aldrich C J, D'Antona D, Spencer J A, Wyatt J S, Peebles D M, Delpy D T, Reynolds E O
机构信息
Department of Obstetrics and Gynaecology, University College London Medical School.
出版信息
Br J Obstet Gynaecol. 1995 Jun;102(6):448-53. doi: 10.1111/j.1471-0528.1995.tb11316.x.
OBJECTIVE
To measure the effect of maternal pushing during the second stage of labour on fetal cerebral oxygenation and blood volume.
DESIGN
A prospective study comparing changes in the fetal cerebral concentrations of oxyhaemoglobin, deoxyhaemoglobin and cerebral blood volume, before and during maternal pushing in the second stage of labour.
SETTING
Teaching hospital obstetric unit.
SUBJECTS
Ten term fetuses during labour.
RESULTS
Following the onset of maternal pushing, mean cerebral deoxyhaemoglobin concentration increased by a mean of 0.79 (SD 0.59) mumol.100 g-1, (P < 0.01) without any consistent change in the oxyhaemoglobin concentration. These changes were associated with a significant decrease in the calculated mean cerebral oxygen saturation from a mean of 46.8% (SD 8.6) to 38.1% (SD 5.2) (P < 0.01). Pushing was also associated with a significant increase in the mean cerebral blood volume, which rose by a mean of 0.33 ml.100 g-1 (SD 0.37) (P < 0.05).
CONCLUSION
Maternal pushing during the second stage of labour leads to a significant decrease in fetal cerebral oxygenation, together with an increase in cerebral blood volume.
目的
测量分娩第二产程中产妇用力对胎儿脑氧合及血容量的影响。
设计
一项前瞻性研究，比较分娩第二产程中产妇用力前和用力时胎儿脑内氧合血红蛋白、脱氧血红蛋白浓度及脑血容量的变化。
地点
教学医院产科病房。
研究对象
10例足月分娩胎儿。
结果
产妇开始用力后，脑脱氧血红蛋白平均浓度平均增加0.79（标准差0.59）μmol·100g-1（P<0.01），而氧合血红蛋白浓度无一致变化。这些变化与计算出的平均脑氧饱和度显著降低有关，从平均46.8%（标准差8.6）降至38.1%（标准差5.2）（P<0.01）。用力还与平均脑血容量显著增加有关，平均增加0.33ml·100g-1（标准差0.37）（P<0.05）。
结论
分娩第二产程中产妇用力导致胎儿脑氧合显著降低，同时脑血容量增加。
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