窒息新生儿动脉血气分析及电解质测定的研究

Arterial blood gas analysis and electrolyte determination for neonates with asphyxia

目的:探讨动脉血气分析及电解质测定对新生儿窒息诊断的价值。方法:选取本科收治的100例窒息新生儿,依据Apgar评分分为轻度窒息组和重度窒息组,另选取50例正常新生儿作为对照组进行对比分析,采用AVL型血气分析仪检测脐动脉血pH值、动脉血压分压(PaO2)、碳酸氢根(HCO3-)、碱剩余(EB)值、动脉血二氧化碳分压(PaCO2)、电解质(K+、Na+、Cl-、Ca2+)。结果:新生儿pH值、PaO2、HCO3-和BE值重度窒息组均低于轻度窒息组及对照组,PaCO2高于轻度窒息组及对照组,差异具有统计学意义(P<0.05);而对照组和轻度窒息组新生儿各指标相比,差异无统计学意义(P>0.05);对照组及轻、重度窒息组新生儿血清K+、Na+、Cl-水平比较,差异无统计学意义(P>0.05);重度窒息组新生儿血Ca2+水平明显低于轻度窒息组及对照组,轻度窒息组与对照组也存在差异,差异均具有统计学意义(P<0.05)。结论:对新生儿动脉血进行血气分析及电解质测定,可弥补Apgar评分的不足,为新生儿窒息的诊断及严重程度的判断提供客观依据,临床结合Apgar评分对提高新生儿窒息的诊断与病情评估的准确性具有重要意义。

Objective： To explore the value of arterial blood gas analysis and electrolyte determination in the diagnosis of neonatal asphyxia. Methods： A total of 100 neonates with asphyxia who were admitted in our department from March, 2013 to March, 2014 were included in the study and divided into the mild asphyxia group and the severe asphyxia group according to Apgar scoring. Moreover, 50 normal neonates were served as the control group and used for comparative analysis. AVL blood -gas analyzer was used to detect the levels of pH, PaO2, HCO3^- , BE, PaCO2, K^＋ , Na^＋ , Cl^- , and Ca^2＋. Results： The concentrations of pH, PaO2, HCO3^-, and BE in the severe asphyxia group were significantly lower than those in the mild as- phyxia group and the control group, while PaCO2 level was significantly higher than that in the mild asphyxia group and the control group （P〈0.05）. There were not significant differences in various indicators between the control group and the mild asphyxia group （P〉0.05）. There were not significant differences in serum K^＋ , Na^＋ , and Cl^- levels among the control group, the mild asphyxia group, and the severe asphyxia group （P〉0.05）. The serum Ca^2＋ level in the severe asphyxia group was significantly lower than that in the mild asphyxia group and the control group （P〈0.05）, while the comparison between the mild asphyxia group and the control group was also statistically significant （P〈0.05）. Oonclusions： Blood gas analysis and electrolyte determination to the arterial blood in neonates can compensate for the insufficiency of Apgar scoring and provide an objective evidence for the diagnosis of neonatal asphyxia and the estimation of severity degree. Clinical combination with Apgar scoring is of great significance in enhancing the diagnosis of neonatal asphyxia and the accuracy of severity evaluation.