新生儿窒息后低钙血症的临床特点分析

Analysis on Clinical Characteristics of Hypocalcemia After Neonatal Asphyxia

目的分析窒息新生儿低钙血症的临床特点,为早期诊断提供依据。方法对2006年5月-2009年5月收治的128例窒息新生儿,其中39例合并低钙血症患儿进行回顾性研究。结果窒息新生儿低钙血症发生率为30.5%(39/128),其中轻度窒息11.6%(10/86),重度窒息69%(29/42),重度窒息组低钙血症发生率比轻度窒息组高,差异有统计学意义(P<0.01)。窒息患儿低钙血症临床表现为:心率减慢87.2%(34/39),心音低钝82.1%(32/39),惊厥74.4%(29/39),心电图示Q-T间期延长43.6%(17/39),以上临床表现的发生率较单纯窒息组高(P<0.05)。出现低钙血症时间:轻度窒息组(36±6.2)h,重度窒息组(10±0.8)h;血清离子钙水平:重度窒息组低达(0.43±0.10)mmol/L,轻度窒息组为(0.65±0.13)mmol/L;纠正患儿血钙到症状消失需补充钙剂次数:轻度窒息组(2±0.2)次,重度窒息组(4±0.6)次;两组比较差异均有统计学意义(P<0.001)。因合并多器官功能衰竭死亡3例。结论窒息并低钙血症时心率减慢,Q-T间期延长,心音低钝,惊厥的发生率增高,与低钙血症有相关性,但不易与窒息所致的心肌及脑损伤相区分,确诊需依靠化验血清离子钙。窒息程度越重,低钙血症发生率越高,低钙血症出现越早,血清离子钙越低,越难纠正。补充钙剂能有效改善以上症状、体征,且安全。

Objective To analyze the clinical features of hypocalcemia after neonatal asphyxia,and to provide the evidence for early diagnosis. Methods A retrospective study was conducted among 128 inpatients with neonatal asphyxia from May 2006 to May 2009,including 39 cases of neonatal asphyxia combined with hypocalcemia. Results The occurrence rate of hypocalcemia after neonatal asphyxia was 30.5% （39/128）,with mild degree of 11.6% （10/86） and severe degree of 69% （29/42）. The incidence rate of hypocalcemia in the severe asphyxia group was higher than that in the mild asphyxia group,and the difference was statistically significant （P0.01）. The clinical manifestations of hypocalcemia after neonatal asphyxia were slow heart rate （87.2%,34/39）,low and dull heart sound （82.1%,32/39）,convulsion （74.4%,29/39）,and a prolonged Q-T interval in ECG （43.6%,17/39）; and the incidence rates of the above manifestations in the hypocalcemia after neonatal asphyxia group were higher than those in the simple neonatal asphyxia group （P0.01～0.05）. The time of onset of hypocalcemia,the serum levels of ionized calcium,the times of calcium medication necessary to correct hypocalcemia of the mild asphyxia group and the severe asphyxia group were （36±6.2） hrs and （10±0.8） hrs,（0.65±0.13） mmol/L and （0.43±0.10） mmol/L,（2±0.2） times and （4±0.6） times,respectively; and there were statistically significant differences between the two groups （P0.001）. Three cases died of hypocalcemia combined with multiple organ failure. Conclusions The high occurrence rates of slow heart rate,prolonged Q-T interval,low and dull heart sound,and convulsion are correlated with the occurrence of hypocalcemia in neonatal asphyxia combined with hypocalcemia,which are difficult to distinguish from the mainfestations of aphyxia combimed with brain and heart muscle damage. Therefore,serum calcium test is needed to confirm hypocalcemia after neonatal asphyxia. The severer the asphyxia and the higher incidence rate of hypocalcemia,the earlier occurrence of hypocalcemia and the lower concentration of serum ionized calcium,the more difficult to recover. Adding calcium is a good and safe method in improving the treatment of hypocalcemia after neonatal asphyxia.