妊娠病理状态下胎儿血氧代谢的变化及其临床管理
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摘要
<正>成人氧代谢通过肺部直接与外界进行氧气交换,而胎儿血氧代谢通过胎盘屏障实现氧气交换。胎儿氧供依赖于充足的母体含氧量、子宫-胎盘及胎盘-胎儿血流以及富氧血的正常分布。胎盘血流、母体-胎儿间的氧分压差以及氧含量(母体的携氧能力)、胎盘血氧弥散面面积及弥散膜的厚度是胎儿氧代谢的决定因素。影响母体携氧及胎盘-胎儿血氧交换等的妊娠病理状况均可影响胎儿血氧代谢。1胎儿氧代谢生理生理条件下,胎儿静脉血(富氧血)氧分压不
引文
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[2]McEvoy A,Tetrokalashvili M.Physiology,pregnancy contractions[M].Treasure Island(FL):StatPearls Publishing,2018:12.
[3]Kapaya H,Broughton Pipkin F,Hayes-Gill B,et al.Circadian changes and sex-related differences in fetal heart rate parameters[J].Matern Health Neonatol Perinatol,2016,2(1):9.
[4]Vintzileos AM,Smulian JC.Decelerations,tachycardia,and decreased variability:have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia?[J].Am J Obstet Gynecol,2016,215(3):261-264.
[5]刘卫红,李笑天,潘明明.胎儿电子监护和脐血流与胎儿窘迫的关系[J].中国实用妇科与产科杂志,2002,18(5):279-282.
[6]Pedaballe AR,Chhabra HS,Tandon V,et al.Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome:a case report and literature review[J].Spinal Cord Ser Cases,2018,23(4):93.
[7]Braems G,Kunzel W,Lang U.Transcutaneous PCO2 during labor-a comparison with fetal blood gas analysis and transcutaneous PO2[J].Eur J Obstet Gynecol Reprod Biol,1993,52(2):81-88.
[8]Plante LA.Management of sepsis and septic shock for the obstetriciangynecologist[J].Obstet Gynecol Clin North Am,2016,43(4):659-678.
[9]Ward KR,Tiba MH,Ryan KL,et al.Oxygen transport characterization of a human model of progressive hemorrhage[J].Resuscitation,2010,81(8):987-993.
[10]Mendez-Figueroa H,Dahlke JD,Vrees RA,et al.Trauma in pregnancy:an updated systematic review[J].Am J Obstet Gynecol,2013,209(1):1-10.
[11]黄莉萍,余艳红.产科急性失血性休克液体复苏和器官功能保护[J].中国实用妇科与产科杂志,2012,28(8):593-597.
[12]Crawford JT,Edelman AB,Pereira L,et al.The effects of vasopressin injection on uterine artery blood flow during dilation and evacuation[J].Am J Obstet Gynecol,2012,196(5):e38-39.
[13]Stroustrup A,Plafkin C.A pilot prospective study of fetomaternal hemorrhage identified by anemia in asymptomatic neonates[J].J Perinatol,2016,36(5):366-369.
[14]Park YS,Hoh JK.Complex and irregular heart rate dynamics in fetuses compromised by maternal anemia as a high-risk pregnancy[J].J Perinat Med,2015,43(6):741-748.
[15]Elenga N,Adeline A,Balcaen J,et al.Pregnancy in sickle cell disease is a very high-risk situation:an observational study[J].Obstet Gynecol Int,2016,2016:9069054.doi:10.1155/2016/9069054.
[16]Hasegawa J,Ikeda T,Toyokawa S,et al.Relevant obstetric factors associated with fetal heart rate monitoring for cerebral palsy in pregnant women with hypertensive disorder of pregnancy[J].J Obstet Gynaecol Res,2018,44(4):647-654.
[17]彭婷,李笑天.妊娠期高血压疾病并发胎盘功能障碍性疾病及其诊治[J].中国实用妇科与产科杂志,2011,27(12):902-905.
[18]刘慧姝,秦爽,黄天晴.重度子痫前期并发多器官功能障碍综合征临床诊治特点[J].中国实用妇科与产科杂志,2011,27(12):919-922.
[19]Guy GP,Ling HZ,Garcia P,et al.Maternal cardiac function at35-37 weeks'gestation:prediction for preeclampsia and gestational hypertension[J].Ultrasound Obstet Gynecol,2017,49(1):39-44.
[20]McGuire W.Perinatal asphyxia[J].BMJ Clin Evid,2007,2007.pii:0320.
[21]Herrera CA,Silver RM.Perinatal asphyxia from the obstetric standpoint:diagnosis and interventions[J].Clin Perinatol,2016,43(3):423-438.
[22]Ng YHG,Ee TX,Kanagalingam D,et al.Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis[J].BMJ Case Rep,2018,2018.pii:bcr-2017-221325.doi:10.1136/bcr-2017-221325.
[23]Morrison FJR,Movassaghian M.Fetal outcomes after diabetic ketoacidosis during pregnancy[J].Diabetes Care,2017,40(7):e77-e79.
[24]王子莲,陈汉青.妊娠合并糖尿病与死胎[J].中国实用妇科与产科杂志,2017,33(11):1125-1128.
[25]杨金英,刘慧姝.胎儿宫内复苏[J].中国实用妇科与产科杂志,2012,28(8):600-604.
[26]康郁林,冯丹,郑韦桦,等.儿童低钾性肾小管疾病38例临床分析[J].中国实用儿科杂志,2018,33(4):286-290.
[27]Ananth CV,Lavery JA,Friedman AM,et al.Serious maternal complications in relation to severe pre-eclampsia:a retrospective cohort study of the impact of hospital volume[J].BJOG,2017,124(8):1246-1253.
[28]Sharma KJ,Esakoff TF,Guillet A,et al.Pregnancies complicated by both preeclampsia and growth restriction between 34 and37 weeks'gestation are associated with adverse perinatal outcomes[J].J Matern Fetal Neonatal Med,2017,30(19):2342-2345.
[29]East CE,Leader LR,Sheehan P,et al.Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a nonreassuring fetal heart rate trace[J].Cochrane Database Syst Rev,2015,(5):CD006174
[30]杨琳,黄绍平.儿童难治性癫痫抗癫痫药物治疗策略[J].中国实用儿科杂志,2016,31(1):5-10.
[31]Weiner E,Fainstein N,Schreiber L,et al.The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries[J].J Perinatol,2015,35(11):919-923.
[32]陈超.早产儿目标血氧饱和度范围的争议[J].中国实用儿科杂志,2018,33(5):341-345.