新生儿脐动脉血pH值联合1minApgar评分检测的应用

The clinical application of combined analysis of neonatal umbilical artery blood pH and 1 min Apgar score

目的探讨新生儿脐动脉血pH值联合1minApgar检测的应用价值。方法选取分娩新生儿206例为研究对象，其中临床诊断胎儿窘迫92例，无胎儿窘迫114例。胎儿娩出后立即行脐动脉血气分析和1minApgar评分，依据是否胎儿窘迫和1minApgar评分分组，并追踪新生儿结局。结果（1）胎儿窘迫组中脐动脉血pH值〈7．20者70例（76．1％），无胎儿窘迫组中为56例（49．1％），差异有统计学意义（P〈0．01）。（2）新生儿1minApgar评分〉7分者中脐动脉血pH值〈7．20者46例（40．4％），而Apgar评分≤7分者中为73例（79．3％），差异有统计学意义（P〈0．01）。（3）脐动脉血气及Apgar评分对新生儿缺血缺氧性脑病（HIE）的预测：HIE发生26例。Apgar评分≤7分对HIE诊断敏感度为88．5％，特异性为61．7％；pH值〈7．20对HIE诊断的敏感度76．9％，特异性45．0％。联合检测对HIE诊断的敏感性为90．5％，特异性为55．0％。结论血气分析是Apgar评分的补充，二者结合能增加对HIE诊断的特异性。

Objective To investigate the clinical value of neonatal umbilical artery blood combined analysis of neonatal umbilical artery blood pH and 1 min Apgar score. Methods 206 cases of newborn were selected as research objects, in which 92 cases with fetal distress and 114 cases with- out fetal distress. Immediate umbilical artery blood gas analysis and 1 minApgar assessments were ap- plied after the childbirth. Neonate were grouped according to diagnosis of fetal distress and 1 minApgar assessments. Results （1） In neonate with fetal distress, 70 cases （76.1%） were detected with um- bilical arterial blood pH 〈 7.20. In those without fetal distress, 56 cases （49.1%） were detected with umbilical arterial blood pH 〈 7.20. there was a significant difference （P 〈 0.01 ）. （2） Forty six cases （40.4%） with umbilical artery blood pH 〈 7.20 were observed in those with 1 minApgar score 〉 7 points, and 73 cases （79.3%） were found in those with 1 minApgar seore≤7 points, with a signifi- cant difference （P 〈 0. 01 ）. （3） A total of 26 cases were diagnosed with neonatal hypoxic ischemie en- cephalopathy （HIE）. The sensitivity and specificity of Apgar score≤7 points for diagnosing HIE was 88.5% and 61.7%, respectively. The sensitivity and specificity of pH values 〈 7.20 to HIE were 76. 9% and 45.0%, respectively. The sensitivity and specificity of combined test to HIE were 90.5% and 55.0%, respectively. Conclusion Blood gas analysis is a supplement to the Apgar score. The combination of two tests can increase the specificity of HIE diagnosis.