Apgar评分与早产儿窒息相关因素的研究

A study of Apgar score and relative factors of asphyxia in premature

目的探讨Apgar评分与早产儿窒息相关因素的关系。方法采用同期住院的早产儿,分成三组:(1)无窒息组(Apgar评分8～10分);轻度窒息组(Apgar评分4～7分);重度窒息组(Apgar评分0～3分),然后分析各组与围产因素、动脉血pH值、血糖及早产儿脑损伤的关系。结果(1)重度窒息组的围产因素明显高于无窒息组和轻度窒息组(P<0·01),而后二组则无显著差异(P>0·05)。(2)首次动脉血气pH值≤7·2的病例,重度窒息组也显著多于无窒息组与轻度窒息组(P<0·01),无窒息组与轻度窒息组则无显著差异(P>0·05)。(3)重度窒息组发生严重低血糖(≤1·1mmol/L)的病例要明显高于无窒息组和轻度窒息组(P<0·01),后二组则无显著差异(P>0·05)。(4)出现脑损伤的情况:缺氧缺血性脑损伤(HIE)、脑室周周-脑室内出血(PIVH)及脑室周周白质软化(PVL),重度窒息组均显著高于无窒息组和轻度窒息组(P<0·01),轻度窒息组与无窒息组则无显著差异性(P>0·05)。结论Apgar评分评估早产儿轻度窒息时(4～7分),应考虑到各种影响因素,其准确性有一定的限度。但Apgar评分0～3时,则发生窒息的可能性大,需按窒息儿处理,以减少脑损伤的发生。

Objective ： To investigate the relationship between Apgar score and relative factors of asphyxia in premature. Methods ： Hospitalized premature infants during the same period were divided into three groups： （1） no asphyxia group （Apgar score 8 -10） ; （2） mild asphyxia （ Apgar score 4 - 7 ） ; （ 3 ） severe asphyxia （ Apgar score 0 - 3 ）. The relationship between relative factors, blood pH value , blood sugar level and brain damage of premature was studied in each group. Results. （ 1 ） Premature infants in severe asphyxia group have more perinatal factors than infants in no asphyxia group and mild asphyxia group （ P 〈 0.01 ）. There was no significant difference between the later two groups. （2） In severe asphyxia group, there were obviously more cases with pH ≤ 7.2 in first artery blood gas analysis after birth than that in no asphyxia group and mild asphyxia group （ P 〈0.01 ）. There was no significant difference between no asphyxia group and mild asphyxia group . （3） There was more severe hypoglycemia （ blood sugar ≤1. lmmoL/L） cases in severe asphyxia group than in no asphyxia group and mild asphyxia group （ P 〈0. 01 ）. There was also no significant difference between the later two groups. （4） The morbidity of Hypoxia Ischemia Encepholophathy （HIE） , periventricular - intraventricular hemorrhage （PIVH） and periventricular white matter malacia （PVL） were obviously higher in severe asphyxia group than in no asphyxia group and mild asphyxia group （ P 〈 0. 01 ）. There was no significant difference between the later two groups. Conclusion ： Using Apgar score to evaluate mild asphyxia in premature , we should consider various influence factors and its accuracy is limit. But when Apgar score is 0 - 3, asphyxia will possibly occur, then management of asphyxia should be done to decrease brain damage.