基于循证医学下的胎儿宫内复苏

刘思华; 罗漫灵; 黄莉萍

doi:10.19538/j.fk2026040105

PDF(998 KB)

中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (4) : 403-405. DOI: 10.19538/j.fk2026040105

专题笔谈

基于循证医学下的胎儿宫内复苏

作者信息 +

Intrauterine fetal resuscitation based on evidence-based medicine

Author information +

文章历史 +

摘要

胎儿宫内复苏是处理胎儿窘迫的关键手段，但各类宫内复苏措施在适应证、实施时机及围产结局影响方面证据不一，部分疗效仍存争议。文章结合国内外指南与循证证据，系统梳理常用胎儿宫内复苏措施的机制与适用情境，并提出以纠正可逆因素为核心的阶梯式管理路径，以供临床参考。

Abstract

Intrauterine fetal resuscitation is an important intervention in the management of fetal distress. However，evidence on resuscitative measures remains inconsistent regarding the indications，implementation timing，and effects on perinatal outcomes， and some therapeutic effects are controversial. Based on current national and international guidelines and evidence-based evidence，the mechanisms and suitable settings of application of commonly used intrauterine resuscitation measures are systematically summarized，and a stepwise management approach focusing on the correction of reversible causes is proposed.

导出引用

刘思华, 罗漫灵, 黄莉萍. 基于循证医学下的胎儿宫内复苏[J]. 中国实用妇科与产科杂志. 2026, 42(4): 403-405 https://doi.org/10.19538/j.fk2026040105

LIU Si-hua, LUO Man-ling, HUANG Li-ping. Intrauterine fetal resuscitation based on evidence-based medicine[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2026, 42(4): 403-405 https://doi.org/10.19538/j.fk2026040105

中图分类号： R714.45

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	ACOG. ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring:Interpretation and Management[J]. Obstet Gynecol, 2025, 146(4):583-599. DOI:10.1097/AOG.0000000000006049. 本文引用 [4]

[2]	O'Heney J, McAllister S, Maresh M, et al. Fetal monitoring in labour:summary and update of NICE guidance[J]. BMJ, 2022,379:o2854.DOI:10.1136/bmj.o2854. 本文引用 [4]

[3]	中国妇幼保健协会, 中国医药教育协会围产医学教育专业委员会. 产前和产时电子胎心监护临床实践专家共识[J]. 中国实用妇科与产科杂志, 2022, 38(7):714-725.DOI:10.19538/j.fk2022070111. 本文引用 [1]

[4]	Dore S, Ehman W. No. 396-Fetal Health Surveillance:Intrapartum Consensus Guideline[J]. J Obstet Gynaecol Can, 2020, 42(3):316-348.e9. DOI:10.1016/j.jogc.2019.05.007. 本文引用 [3]

[5]	Queensland Health. Intrapartum fetal surveillance:Queensland clinical guideline[R]. Brisbane: Queensland Health, 2025. 本文引用 [3]

[6]	Humphries A, Mirjalili SA, Tarr GP, et al. The effect of supine positioning on maternal hemodynamics during late pregnancy[J]. J Matern Fetal Neonatal Med, 2019, 32(23):3923-3930. DOI:10.1080/14767058.2018.1478958. 本文引用 [1]

[7]	Couper S, Clark A, Thompson JMD, et al. The effects of maternal position,in late gestation pregnancy,on placental blood flow and oxygenation:an MRI study[J]. J Physiol, 2021, 599(6):1901-1915. DOI:10.1113/JP280569. 本文引用 [1]

[8]	Alus M, Okumuş H, Mete S, et al. The effects of different maternal positions on non-stress test:an experimental study[J]. J Clin Nurs, 2007, 16(3):562-568. DOI:10.1111/j.1365-2702.2006.01570.x. 本文引用 [1]

[9]	Wu S, Liao G, Yang J. Effects of Right lateral position on changes of fetal hemodynamics in late pregnancy[J]. J Ultrasound Med, 2023, 42(10):2341-2347. DOI:10.1002/jum.16261. 本文引用 [1]

[10]	Fawole B, Hofmeyr GJ. Maternal oxygen administration for fetal distress[J]. Cochrane Database Syst Rev, 2012, 12(12):CD000136. DOI:10.1002/14651858.CD000136.pub2. 本文引用 [1]

[11]	Raghuraman N, López JD, Carter EB, et al. The effect of intrapartum oxygen supplementation on category Ⅱ fetal monitoring[J]. Am J Obstet Gynecol, 2020, 223(6):905.e1-905.e7. DOI:10.1016/j.ajog.2020.06.037. 本文引用 [1]

[12]	Chuai F, Dong T, Liu Y, et al. The effect of intrapartum prolonged oxygen exposure on fetal metabolic status:secondary analysis from a randomized controlled trial[J]. Front Endocrinol (Lausanne), 2023, 14:1204956. DOI:10.3389/fendo.2023.1204956. 本文引用 [1]

[13]	Hofmeyr G, Cyna A, Middleton P. Prophylactic intravenous preloading for regional analgesia in labour[J]. Cochrane Database Syst Rev, 2004, 2004(4): CD000175. DOI:10.1002/14651858.CD000175.pub2. 本文引用 [1]

[14]	Xu C, Liu S, Qian D, et al. Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia:A randomized controlled trial[J]. Int J Surg, 2019, 62:5-11. DOI:10.1016/j.ijsu.2018.12.014. 本文引用 [1]

[15]	陈锡龙, 周冰莹, 张太宁, 等. 儿童脓毒性休克液体复苏的最佳实践[J]. 中国实用儿科杂志, 2024, 39(9):674-679. DOI:10.19538/j.ek2024090606. 本文引用 [1]

[16]	Leathersich SJ, Vogel JP, Tran TS, et al. Acute tocolysis for uterine tachysystole or suspected fetal distress[J]. Cochrane Database Syst Rev, 2018, 7(7):CD009770. DOI:10.1002/14651858.CD009770.pub2. 本文引用 [1]

[17]

Xodo

, de Heus

, Berghella

, et al. Acute tocolysis for intrapartum nonreassuring fetal status:how often does it prevent cesarean delivery? A systematic review and meta-analysis of randomized controlled trials[J]. Am J Obstet Gynecol MFM, 2022, 4(5):100639. DOI:10.1016/j.ajogmf.2022.100639.

本文引用 [1]

[18]	郑峥, 狄小丹, 毛迪, 等. 特布他林与硝苯地平用于产时胎儿宫内复苏:前瞻性随机对照研究[J]. 中华围产医学杂志, 2022, 25(2):129-135. 本文引用 [1]

[19]	Polnaszek BE, Rossen J, Bligard KH, et al. Intrapartum amnioinfusion for recurrent variable decelerations and neonatal morbidity:a systematic review and meta-analysis[J]. Clinical and Experimental Obstetrics & Gynecology, 2024, 51(3):75.DOI:10.31083/j.ceog5103075. 本文引用 [1]

[20]

Davis

, Sanchez-Ramos

, McKinney

, et al. Intrapartum amnioinfusion reduces meconium aspiration syndrome and improves neonatal outcomes in patients with meconium-stained fluid:a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2023, 228(5S):S1179-S1191.e19. DOI:10.1016/j.ajog.2022.07.047.

本文引用 [1]

[21]	de Ruigh AA, Simons NE, van 't Hooft J, et al. Child outcomes after amnioinfusion compared with no intervention in women with second-trimester rupture of membranes:a long-term follow-up study of the PROMEXIL-III trial[J]. BJOG, 2021, 128(2):292-301. DOI:10.1111/1471-0528.16115. 本文引用 [1]

[22]	郭晓辉, 石苇. 产时电子胎心监护分类及处理[J]. 中国实用妇科与产科杂志, 2024, 40(2):138-142. DOI:10.19538/j.fk2024020103. 本文引用 [1]

[23]	单佳妮, 张晨美, 赵仕国, 等. 美国2023版新生儿复苏指南的改变及当代欧美指南的差异性分析[J]. 中国实用儿科杂志, 2025, 40(6):452-458. DOI:10.19538/j.ek2025060602. 本文引用 [1]

[24]	唐灵儿, 王妍. 机器学习在产前电子胎心监护领域的应用[J]. 中国实用妇科与产科杂志, 2024, 40(4):470-472. DOI:10.19538/j.fk2024040119. 本文引用 [1]

[25]	Fieni S, Morganelli G, Chandraharan E, et al. Intrauterine fetal resuscitation:from maternal repositioning to the latest pharmacological strategies[J]. J Matern Fetal Neonatal Med, 2025, 38(1):2502977. DOI:10.1080/14767058.2025.2502977. 本文引用 [1]