危重新生儿血清电解质变化与器官功能障碍的关系

The relationship of change of serum electrolyte and multi-organ dysfunction in critical neonates

目的探讨危重新生儿并发多器官功能障碍时血气及血电解质的变化。方法对63例入院时经过新生儿危重评分法确定为危重儿、最终发展为多器官功能障碍的新生儿的血清电解质变化与器官功能障碍程度进行回顾分析。结果随着器官障碍数的增加,其病死率增加;低钠血症、高钾血症、低钙血症、低镁血症的发生率也显著增加。低血pH值组与正常pH值组比较其血PCO2明显增高,血HCO3-、PO2明显降低。而高血pH组与正常血pH组比较,PCO2、HCO3-、PO2差异均无显著性,但血氯水平明显降低。低钠血症组神经系统功能障碍发生率明显增高,ALT、CK-MB及LDH水平亦明显增高,低钠血症的同时伴有明显低氯血症,血清C l-、血清K+、血清Ca2+、血清Mg2+均明显降低。高钾血症组患儿血ALT、AST、BUN、TB、IB水平均高于正常血钾组。低钙血症组与正常血钙组比较血AST、CK、CK-MB、LDH水平明显增高,血清Mg2+水平明显降低。结论器官障碍数越多,电解质异常的发生率越高。低钠血症时,神经系统功能障碍的发生率明显增高,同时伴有低钾、低钙、低镁血症。低钙血症存在明显肝、心功能损害。当肾功能损害和严重溶血时血钾明显增高。血钙及血镁水平能反映病情的严重程度。

Objective To explore the change of serum electrolyte in critical neonates with multi-organ dysfunction. Methods 63 cases of critical neonates, according to neonatal critical score, were collected. All of 63 cases were complicated with multi-organ dysfunction finally. The relationship between serum electrolyte and multi-organ dysfunction was analyzed. Results Morbidity, incidence rate of hyponatremia, kaliopenia, hypocalcemia and hypomagensiumia increased with the number of organ dysfuntion increased. PCO2 was significantly higher, HCO3^- , PO2 were significantly lower in the group with low pH value than that in the group with normal pH value. PCO2, HCO3^- , PO2 were insignificantly different, except that serum K^＋ was significantly lower in the group with high pH value than that in the group with normal pH value. Incidence of neurological dysfunction in hyponatremia group increased with low Cl^- , K^＋ , Ca^2＋ , Mg^2＋ and high ALT, CK-MB and LDH in the blood serum. ALT, AST, BUN, TB, and IB were significantly higher in the group with hyperpotassemia than that in the group with normal potassium. AST, CK, CK-MB, and LDH were significantly higher and the blood Mg^2＋ levels were lower in the group with hypocalcemia than that in the group with normal serum calcium. Conclusion Incidence rate of hyponatremia, kaliopenia, hypocalcemia, and hypomagensiumia increased with the number of organ dysfunction increased. Incidence of neurological dysfunction patients significantly increased. Concentrations of blood Ca^2＋ and Mg^2＋ are indicators of the disease severity.