围生期窒息新生儿血气变化与神经系统损害的关系

Relationship between blood gas alteration and neurologic impairment in neonatal asphyxia during perinatal period

目的探讨围生期窒息新生儿PaCO2、pH及剩余碱变化与其神经系统损害之间的关系。方法将100例足月窒息新生儿分为3组,A组:pH>7.00,PaCO2<50mmHg,剩余碱无明显改变,无神经系统异常;B组:pH≤7.00,PaCO2>50 mmHg、剩余碱≤-10,无神经系统异常;C组:pH≤7.00、PaCO2>50 mmHg、剩余碱≤-15,有神经系统异常。采集患儿脐动脉血、产后1小时桡动脉血进行血气分析,并观察A pgar评分和临床经过。结果脐动脉血pH、PaCO2和剩余碱各组间差异有显著性;产后1小时桡动脉血pH值A组与C组、B组与C组间差异有显著性;产后1小时桡动脉血pH、PaCO2分别和脐动脉血pH、PaCO2比较,差异有显著性;三组间有不同神经系统表现;Apgar评分C组较低。结论在严重酸中毒时,胎儿出生后pH、PaCO2及剩余碱会发生显著改变,剩余碱显著异常的患儿有不良神经系统预后。

Objective To explore the relationship between the changes in PaCO2,pH value,BE and neurologic impairment in asphyxia infants in presence of severe acidemia. Methods Umbilical arterial blood and radial arterial blood at postnatal 1h were checked in 100 infants. These infants were classified into three groups： group A, phi7.00, PaCO2〈50mmHg, normal BE and neurologic function; group B, pH≤7. 00, PaCO2〉50 mmHg, BE≤-10, normal neurologic function group C, pHi7.00, PaCO2〉50 mmHg, BE≤-15,abnormal neurologic function. Results There was significant difference in pH, PaCO2, and BE in umbilical arterial blood among the three groups. At postnatal lh, pH increased and PaCO2 decreased in all groups, being significantly different between groups. There were varied degrees of neurologic impairment in three groups. Apgar score was lowest in group C. Conclusion After delivery, pH, PaCO2 and BE of neonates will present abnormal changes in presence of severe acidemia. Abnormal BE often suggests a poor neurologic prognosis.