脐带血血气分析对围出生期窒息新生儿预后的预测

The effect of omphalo-blood gas analysis for predicting the prognosis of asphysia neonate.

目的 研究Paco2、脐动—静脉Pa -vco2 差 (△Pa -vco2)、脐动—静脉Pa -vO2 差 (△Pa -vo2) ,剩余碱(BE)对窒息新生儿预后的预测作用。方法1998年7月～2000年7月 ,根据Apgar评分 ,共有217名窒息新生儿 ,PH<7.00组25例 ,PH7.00～7.09组48例 ,PH≥7.10组144例 ,监测所有窒息新生儿脐动、静脉PH、Po2、Pco2、BE ,利用PH<7.00组窒息新生儿发生并发症和相对无并发症血气分析值不同 ,计算并发症组窒息新生儿Paco2、△Pa -vco2、△Pa -vo2、BE值的95 %最低限 ,观察这些值对所有窒息新生儿预后的预测作用。结果 PH<7.00组窒息新生儿并发症的发生率明显高于PH≥7.00组窒息新生儿 ,△Pa -vco2≥24mmHg对窒息新生儿预后的敏感性为95%,但特异性较差 ,Pa co2≥80mmHg的敏感性为86%,△Pa -vO2 敏感性、特异性均较差 ,而BE≤ -10mmol/L特异性高达97 %,敏感性为77%。 结论 Pa co2≥80mmHg或△Pa -vco2≥24mmHg比较敏感反映胎儿宫内早期窘迫 ,BE≤ -10mmol/L特异性反映新生儿并发症的存在。

Objective To study the effect of omphalo- blood gas analysis on predicating the prognosis of asphyxia neonate. Methods According to Apgar score,217 asphyxia neonates were randomized into 3 groups group A (PH<7.00,25 cases),group B (PH 7.00～7.09, 48 cases), group C ( PH≥7.10,144 cases).All neonate had omphalo- blood gas analysis to monitor PH,Po2,Pco2 and BE. Analysis was then made to observe the predicative effect of these index. Result The incidence of asphyxia neonate complications in group A was significantly higher than that in group B. The sensibility of prognosis in asphyxia neonate with △Pa-vco2≥24mmHg was 95%, but showed a bad specificity. The sensibility of prognosis in asphyxia neonate with BE≤-10mmol/L was 97%, and showed a high specificity of 77%. Conclusion Paco2≥80mmHg and △Pa-vco2≥24mmHg can sensitively reflect earlier fetus embarrass,BE≤-10mmol/L can specifically indicate the existence of asphyxia neonate complications.