研究产时羊水粪染(meconium-staind amniotic fluid, MSAF)新生儿脐动脉血乳酸水平的变化及与血气分析新生儿结局的关系。

2005年2月至2006年3月245例足月妊娠、单胎、头位，无产科、内科合并症产妇，根据产时羊水有无MSAF分为两组，MSAF组(n = 50)，清亮组(n= 195)，检测脐动脉血乳酸、血气分析，以及新生儿行为神经测定(neonatal behavioral neudogioal assessment，NBNA)。

MSAF组与清亮组脐动脉血乳酸水平、pH值及碱剩余(BE)比较，差异无显著意义(P> 0.05)。脐血乳酸水平在MSAF程度之间，差异无显著意义(P>0.05)。脐血乳酸与pH值、BE呈明显负相关关系(r=-0.64，r=-0.63，P<0.01)。MSAF组合并产时异常胎心监护图形、酸中毒者，其脐动脉血乳酸水平明显升高，差异有显著意义(P<0.05，P<0.01)。新生儿NBNA评分，两组间相比差异无显著意义(P>0.05)。

脐动脉血乳酸水平与pH值、BE有较好的相关性，产时单纯MSAF与提示急性窒息的指标乳酸无明显关系。

To determine whether umbilical artery lactate level were significantly different in infant with or without intrapartum meconium-stained amniotic fluid(MSAF).

245 term parturients with cephalia precentation, singleton fetus, without obstetric and medical complications from February 2005 to March 2006 were divided into two groups, in which there were 50 cases in MSAF group and 195 cases in clear group, on the basis of the presence or absence of MSAF.The lactate level and acid-base balance were measured at each delivery.At 4~6th and 26~28th day after birth, neonatal behavioral neudogioal assessment(NBNA)was taken for each newborn.

There were no significant differences in mean lactate level, pH value and BE in newborns with meconium compared with clear fluid(P>0.05).The lactate levels in MSAF group was negatively correlated with the pH value and BE(r=-0.64 and -0.63 respectively, both P<0.01).Compared with that in clear group, the lactate level was significantly higher in the group of MSAF with abnormal cardiotocography(CTG)and acidosis(P<0.05, P<0.01).There was no a significant correlation between the lactate level and the degree of thickness of meconium(P>0.05).There was no a difference of NBNA score at the 4〜6th and 26〜28th day after birth between MSAF and clear group(P>0.05).

This study were unable to demonstrate significant differences between the umbilical artery lactate levels in newborns with MSAF compared with infants with clear fluid.Otherwise, it was proved that all of the lactate level, pH value and BE in cord blood had similar predictive value for there was significant correlation between them.