新生儿生后早期外周动脉血气分析评估缺氧损伤的意义

The relationship of peripheral arterial blood gas and organ injury after neonatal asphyxia

目的探讨生后早期外周动脉血气分析对于新生儿窒息病情评判的临床价值。方法选取2012年3月至2013年4月本院新生儿科收治的足月窒息新生儿为观察组,其中1 min Apgar评分4-7者为轻度窒息组,≤3分者为重度窒息组,同期随机选取无窒息的足月新生儿为对照组,各组新生儿均在生后1 h内取右手桡动脉血进行血气分析并比较。将窒息组按外周动脉血气pH值分为〉7.25、7.0-7.25、〈7.0三组,比较各组发生脏器功能受损的比例。结果轻度窒息组98例,重度窒息组24例,对照组86例。各组新生儿性别、胎龄、出生体重、分娩方式、取血时间等差异均无统计学意义（P〉0.05）。对照组pH值和BE值均高于轻、重度窒息组[pH：（7.38±0.06）比（7.16±0.08）、（7.10±0.09）,BE：（-4.1±0.5）mmol/L比（-11.1±4.6）mmol/L、（-14.4±2.6）mmol/L,P〈0.05],轻、重度窒息组之间差异无统计学意义（P〉0.05）。窒息组患儿中,外周动脉血气pH值〉7.25组、7.0~7.25组和〈7.0组发生脏器功能受损的比例分别为53.3%、88.9%、100%,差异有统计学意义（P〈0.05）。结论 Apgar评分的轻重程度不能完全代表窒息的程度,生后1 h内外周动脉血气分析检测是弥补其不足的一项客观指标。

Objective To study the value of peripheral arterial blood gas analysis in the evaluation of organ injury after neonatal asphyxia. Methods From March 2012 to April 2013 full term neonates admitted to the neonatal ward with asphyxia were assigned as asphyxia group, and subdivided as mild group with 1 minute Apgar score of 4 to 7, and severe group with 1 minute Apgar score 3 or less than 3. Newborns whose 1 minute Apgar score 〉 8 serve as control group. Right radial artery blood gas were taken within 1 hour after birth. The asphyxia group were further grouped according to the pH level of blood gas as 〈 7.0, 7.0 - 7.25, and 〉 7. 25. Incidence of impaired organ function were compared among these groups. Results A total of 98 cases of mild asphyxia, 24 severe asphyxia and 86 control were enrolled in the study. No statistically significant differences of gender, gestational age, birth weight, delivery methods and blood sampling time （ P 〉 0. 05 ） were found among these groups, pH and Base excess （BE） value of the control group were higher than the mild and severe asphyxia group [ pH ： （7.38 ±0. 06） vs. （7.16 ±0. 08） ,（7. 10 ±0. 09） ,BE： （ -4. 1 ±0. 5） mmol/L vs. （ - 11.1 ±4. 6） mmol/L,（ -14. 4 ± 2.6 ）mmot/L, P 〈 0. 05 ]. There wer no differences between the two asphyxia groups （P 〉 0. 05）. The incidence of impaired organ function is 53.3% in pH 〉7.25 group, 88.9% in 7.0 ±7.25 group and 100% in pH 〈 7.25 group （P 〈 0. 05 ）. Conclusions pH and BE in peripheral arterial blood gas analysis taken within 1 hour after birth can be used as an objective and supplementary evaluation marker of the severity of neonatal asphyxia.