宫内窘迫新生儿脐动脉血乳酸检测与新生儿行为神经测定的临床意义

Clinical evaluation of umbilical artery blood lactate levels and neonatal behavioral neurological assessment in the newborns with fetal distress

目的探讨新生儿脐动脉血乳酸水平与宫内窘迫的关系及其对新生儿行为神经表现的影响。方法对160例发生宫内窘迫的足月新生儿（出生时无窒息为窘迫Ⅰ组，出生时有窒息为窘迫Ⅱ组）和310例正常足月新生儿（对照组）的脐动脉血进行乳酸测定及血气分析，并在生后4～6d、26～28d进行新生儿20项行为神经测定（neonatal behavioral neurological assessment，NBNA）。结果窘迫Ⅰ组和窘迫Ⅱ组脐动脉血乳酸值均较对照组显著升高（P〈0．01），两组pH值较对照组明显降低（P〈0．01）；窘迫Ⅱ组的乳酸值明显高于窘迫Ⅰ组，pH值低于窘迫Ⅰ组，差异均有非常显著性（P〈0．01）。脐血乳酸值与pH值呈直线负相关关系（r=-0．53，P〈0．01），窘迫Ⅱ组的脐血乳酸值与NBNA评分也呈直线负相关关系（r=-0．78，P〈0．01）。三组NBNA评分随日龄增长均升高，差异有非常显著性（P〈0．01）。结论脐动脉血乳酸检测可协助宫内窘迫的诊断，并可望作为评估、预测新生儿窒息损伤的指标之一。

Objective To study the changes of umbilical artery blood lactate level and their effects on neurological behaviour in the newborns with fetal distress. Methods The lactate level and the pH value of umbilical artery blood were detected in 160 term newborns with fetal distress （further divided into distress group I and distress group II, based on without or with neonatal asphyxia） and 310 normal term neonates （the control group）, On the 4th-6th and 26th--28th day after birth, 20-item neonatal behavioral neurological assessment （NBNA） was taken for each subject, Results The lactate levels of umbilical artery blood in the distress group I and distress group II were significantly higher than that in the control group （ P 〈 0.01 ）. The pH values in the distress group I and distress group II were markedly lower than that of the control group （P 〈 0.01）, There were significant differences in the lactate level and pH value between the distress group I and distress group II （ P 〈 0.01 ）. The lactate level was negatively correlated with the pH value （ r = - 0.53, P 〈 0.01）, and there was similar negative correlation between lactate level and the score of NBNA in the distress group II （ r = - 0.78, P〈0.01）. The score of NBNA in all subjects rised with birth days, There was significant difference between the score of NBNA of the 4th- 6th day and 26th - 28th day. Conclusion The level of umbilical artery blood lactate seems to provide the proof for diagnosis of fetal distress, and it may be a useful index in evaluating and observing neonate with perinatal asphyxia.