探讨脐动脉血乳酸水平与胎心监护无应激试验(non-stress test, NST )异常图形及羊水过少新生儿结局之间的关系。

2007年2月至2010年2月在本院住院分娩的羊水过少孕妇140例为研究对象，将其纳入观察组；选取同期羊水量正常的140例孕妇纳入对照组。两组新生儿均为足月、单胎、头位分娩及未并发其他病理因素受试者(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。对所有受试者均在产前(1～2) d进行胎心监护无应激试验[监护(20～40 )min]。对比分析无应激试验监护波形，检测新生儿脐动脉血乳酸水平及生后20项行为神经评分(neonatal behavioral neurological assessment, NBNA)。

观察组孕妇无应激试验基线变异消失和一过性减速等异常常见，可致剖宫产率增加。观察组孕妇脐血乳酸水平明显高于对照组，且差异有显著意义(P<0.01)；脐血pH值、碱剩余(base excess，BE)显著低于对照组，且差异有显著意义(P<0.01)。脐血乳酸水平与pH值、碱剩余值呈显著负相关关系(P<0.01)。

脐血乳酸水平与pH值、碱剩余值有较好的相关性。羊水过少时，无应激试验基线变异消失或一过性减速与围生儿脐血高乳酸水平、不良结局有关。

To study relations between umbilical artery lactate levels, ominous non-stress test (NST)fetal heart rate monitoring and newborn outcomes.

From February 2007 to February 2010, 140 cases hypamnion pregnant women(observation group) who was delivery with uterogestation and singleton fetus, and meanwhile 140 cases with normal amniotic fluid quantity were into control group. All the pregnant women took non-stress test monitoring 20-40 minutes 1-2 days before antepartum. Non-stress test monitoring graph, umbilical artery lactate level in newborn, and neonatal behavioral neurological assessment (NBNA) after birth were taken for each newborn. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Qingdao Central Hospital. Informed consent was obtained from all participants.

The disappearance of non-stress test baseline variability and transient abnormal deceleration were very common in observation group, which could increase the cesarean section rate. The cord blood lactate levels in observation group was higher than that of control group with a significant difference (P<0.01). But the levels of cord blood pH and base excess (BE) in observation group were lower than those of control group (P<0.01). The umbilical cord blood lactate level and pH level, base excess level was negatively correlated.

The umbilical cord blood lactate level and pH level, base excess level have a good correlation. The disappearance of non-stress test baseline variability or transient abnormal deceleration were related with high cord blood lactate level and adverse outcomes in newborns.