妊娠期高血压综合征孕妇新生儿脐血血气分析的临床意义

Clinical significance of blood gas analysis on umbilical cord blood of neonates bore of mothers with pregnancy-induced hypertension syndrome

目的 探讨妊娠期高血压综合征孕妇新生儿早期脐血血气变化及其对机体内环境的影响,评价产后脐血血气分析的临床意义.方法 选择97例妊娠期高血压综合征孕妇所生的101例新生儿作为研究对象,根据分度标准分为轻度组41例,中度组34例,重度组26例,另选择同期52例非妊娠期高血压综合征孕妇所生的52例新生儿作为对照组,两组新生儿均于娩出后第一次呼吸前抽取脐动脉血进行血气分析,测定pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、HCO3-、剩余碱,并于生后1min行Apgar评分.结果 重度组新生儿pH值、PaO2、HCO3-和剩余碱明显低于轻度组、中度组和对照组[7.16±0.18比7.25±0.09,7.22±0.11,7.29±0.08;（12.01±2.75） mmHg（1 mmHg=0.133 kPa）比（18.35±1.75）,（14.21±2.01）,（22.23±1.45） mmHg;（17.11±2.42） mmol/L比（19.82±3.85）,（17.32±3.21）,（22.56±3.38） mmol/L;（-9.15±0.32）mmol/L比（-7.95±0.60）,（-7.21±0.08）,（-6.76±0.03）mmol/L],而PaCO2明显高于轻度组、中度组和对照组[（61.84±32.93） mmHg比（54.48±12.82）,（58.38±15.32）,（51.66±10.52） mmHg],差异均有统计学意义（P＜0.05）.新生儿生后1 min Apgar评分和脐动脉血pH值呈正相关（P＜0.05）.在Apgar评分≤7分的65例新生儿中有37例出现酸中毒（pH值＜7.20）,发生率为56.92％（37/65）;在Apgar评分≥8分的88例新生儿中有11例出现酸中毒,发生率为12.50％（11/88）,比较差异有统计学意义（P＜0.01）.结论 脐动脉血血气分析比Apgar评分客观,能直接反映妊娠期高血压综合征孕妇新生儿缺氧、缺血程度,并有助于判断新生儿预后.对妊娠期高血压综合征孕妇所生新生儿应常规行脐血血气分析,有宫内窘迫征象及出生低Apgar评分的新生儿应加强监护,尽早干预,以提高生育质量.

Objective To investigate the change of umbilical cord blood gas from early-stage neonates with pregnancy-induced hypertension syndrome （PHIS） affected mothers and its influence upon internal environment of body,and to evaluate the significance of postpartum umbilical cord blood gas analysis.Methods Retrospective study of 101 neonates（born of 97 PHIS-affected mothers）,41 cases of mild group,34 cases of moderate group,26 cases of severe group,and enrolled 52 neonates born of non-PHIS mothers as the control group.Prior to neonate＇s first breath,umbilical cord artery blood gas analysis was performedimmediately to determine the values of pH,arterial carbon dioxide partial pressure （PaCO2）,arterial oxygen tension （PaO2）,HCO3-,base excess （BE）,and Apgar score was completed within 1 min after birth.Results The pH,PaO2,HCO3-,BE in severe group was significantly lower than those in mild group,moderate group,and control group [7.16 ± 0.18 vs.7.25 ± 0.09,7.22 ± 0.11,7.29 ± 0.08 ; （12.01 ± 2.75） mmHg （1 mmHg =0.133 kPa） vs.（18.35 ± 1.75）,（14.21 ± 2.01）,（22.23 ± 1.45） mmHg; （17.11 ± 2.42） mmoFL vs.（19.82 ±3.85）,（17.32 ± 3.21）,（22.56 ± 3.38） mmol/L; （-9.15 ± 0.32） mmol/L vs.（-7.95 ± 0.60）,（-7.21 ± 0.08）,（-6.76 ± 0.03） mmol/L] （P 〈 0.05）,the PaCO2 in severe group was significantly higher than that in mild group,moderate group,and control group [（61.84 ± 32.93） mmHg vs.（54.48 ± 12.82）,（58.38 ± 15.32）,（51.66 ± 10.52） mmHg] （P 〈 0.05）,Apgar score 1 min after birth was positively correlated with umbilical arterial pH （P 〈 0.05）,the lower Apgar score,the lower pH.Among 65 cases of Apgar score ≤ 7 scores,37 cases of acidosis （pH 〈 7.20）,the incidence rate was 56.92% （37/65） ; among 88 cases of Apgar score ≥ 8 scores,11 cases of acidosis,the incidence rate was 12.50% （11/88）,the difference was statistically significant （P 〈 0.01）.Conclusions Umbilical cord blood gas analysis is more objective than Apgar score,which could reflect neonate＇s hypoxia-ischemia degree bore of PIHS mothers,as well as contributed to the assessment of neonate＇ s prognosis.Conventional umbilical cord blood gas analysis is necessary for neonates bore of PIHS-affected mothers.Enhanced monitoring should be performed in a timely manner on those neonates born after intrauterine distress signs or with low Apgar score,the prevention and therapy as early as possible can improve the quality of birth.