Richey S D, Ramin S M, Bawdon R E, Roberts S W, Dax J, Roberts J, Gilstrap L C
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.
Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1212-5. doi: 10.1016/0002-9378(95)91481-1.
Cord blood pH, lactate, hypoxanthine, and erythropoietin levels have all been used as markers of either acute or chronic asphyxia. We sought to determine whether these index values were significantly different in infants with or without meconium-stained amniotic fluid.
Fifty-six pregnant women in spontaneous labor at term were divided into two groups on the basis of the presence or absence of meconium-stained amniotic fluid. All meconium-stained fluid was centrifuged, and the volume percentage of particulate matter (i.e., meconium) was recorded. Umbilical artery blood and mixed arterial and venous cord blood were obtained at each delivery. Lactate, hypoxanthine, and erythropoietin levels were measured. Statistical analysis included Student t test and rank sum statistics where appropriate. Normal and Spearman correlation coefficients were also used.
There were no significant differences in mean umbilical artery pH (7.26 +/- 0.06 vs 7.25 +/- 0.10), lactate levels (32.8 +/- 10 mg/dl vs 30.4 +/- 14.2 mg/dl), and hypoxanthine levels (13.4 +/- 6.7 mumol/L vs 14.0 +/- 6.0 mumol/L) in newborns with meconium (n = 28) compared with controls (n = 28). Erythropoietin levels were significantly greater in newborns with meconium (median 39.5 mIU/ml vs 26.8 mIU/ml, p = 0.039). There was no correlation between the amount of particulate matter and any marker of asphyxia.
There was no correlation between markers of acute asphyxia (i.e., umbilical artery blood pH, lactate, or hypoxanthine) and meconium. However, erythropoietin levels were significantly elevated in newborns with meconium-stained amniotic fluid. This latter marker may better correlate with chronic asphyxia.
脐血pH值、乳酸、次黄嘌呤和促红细胞生成素水平均已被用作急性或慢性窒息的标志物。我们试图确定这些指标值在有或没有胎粪污染羊水的婴儿中是否存在显著差异。
56名足月自然分娩的孕妇根据是否有胎粪污染羊水分为两组。所有胎粪污染的羊水均进行离心，并记录颗粒物（即胎粪）的体积百分比。每次分娩时采集脐动脉血以及混合的动脉和静脉脐血。测量乳酸、次黄嘌呤和促红细胞生成素水平。统计分析在适当情况下包括学生t检验和秩和统计。还使用了正态和斯皮尔曼相关系数。
与对照组（n = 28）相比，有胎粪的新生儿（n = 28）的平均脐动脉pH值（7.26 +/- 0.06对7.25 +/- 0.10）、乳酸水平（32.8 +/- 10 mg/dl对30.4 +/- 14.2 mg/dl）和次黄嘌呤水平（13.4 +/- 6.7 μmol/L对14.0 +/- 6.0 μmol/L）无显著差异。有胎粪的新生儿促红细胞生成素水平显著更高（中位数39.5 mIU/ml对26.8 mIU/ml，p = 0.039）。颗粒物数量与任何窒息标志物之间均无相关性。
急性窒息标志物（即脐动脉血pH值、乳酸或次黄嘌呤）与胎粪之间无相关性。然而，有胎粪污染羊水的新生儿促红细胞生成素水平显著升高。后一种标志物可能与慢性窒息有更好的相关性。
