脐动脉血气分析联合Apgar评分对新生儿窒息多器官损害的诊断意义

Umbilical artery blood gas analysis and Apgar score for multiple organ damage after neonatal asphyxia

目的研究脐动脉血气分析及Apgar评分对新生儿窒息多器官损害的诊断意义。方法选取2014年11月—2016年3月期间收治的136例窒息新生儿作为研究对象,所有患儿均经过Apgar评分、脐动脉血气分析检查,比较不同窒息程度评分患儿代谢性酸中毒及多器官损害的发生率。绘制Apgar评分、脐动脉血p H及BE诊断多器官损害的ROC曲线,选取上述指标的临界值,并比较不同指标的敏感度、特异度及曲线下面积。结果136例患儿中32例(23.52%)发生多器官损害,轻度窒息与重度窒息患儿多器官损害发生率的差异具有统计学意义(P<0.05),代谢性酸中毒的差异无统计学意义(P>0.05)。重度酸中毒患儿多器官损伤发生率为87.87%(29/33),非重度酸中毒患儿多器官损伤发生率为6.90%(2/29),非酸中毒患儿多器官损害发生率为1.35%(1/74)。多器官及非多器官损害患儿1 min Apgar评分、p H及BE差异具有统计学意义(P<0.05),5 min Apgar评分的差异无统计学意义(P>0.05)。1 min Apgar评分诊断新生儿窒息多器官损害的AUC为0.535,临界值为3,敏感度为78.13%,特异度为65.38%;p H的AUC为0.712,临界值为7.05,敏感度为90.63%,特异度为96.15%;BE的AUC为0.627,临界值为-15.23 mmol/L,敏感度为78.13%,特异度为88.46%。结论与单纯应用Apgar评分相比,应用脐动脉血p H及BE可以更加准确地评价新生儿窒息多器官损害,提高诊断准确率。

Objective To study the value of umbilical artery blood gas analysis combined with Apgar score in the diagnosis of multiple organ damage after neonatal asphyxia. Methods From November,2014 to March,2016,136 patients with neonatal asphyxia were chosen as study patients,and the umbilical artery blood gas analysis as well as Apgar score was performed in all of them. The ROCs of Apgar score,p H and BE were depicted,and the critical values of Apgar score,p H and BE were confirmed. The specificity,sensitivity and AUC were compared among different indicators. Results In 136 patients with neonatal asphyxia,32 patients（ 23. 52%） were diagnosed with multiple organ damage. The rate of multiple organ damage had significant difference between patients with severe and mild asphyxia（ P 〈0. 05）,the rate of metabolic acidosis had no significant difference between different patients（ P 〉0. 05）. The rate of multiple organ damage in patients with severe acidosis was 87. 87%（ 29 /33）,and in the patients with non-severe acidosis was 6. 90%（ 2 /29）,that in the patients without acidosis was 1. 35%（ 1 /74）. One min Apgar score,p H and BE had significant difference between patients with or without multiple organ damage（ P 〈0. 05）,the difference of 5 min Apgar score had no statistical significance（ P 〉0. 05）. ROC analysis： The AUC of 1 min Apgar was 0. 535,the critical value was 3,the sensitivity was 78. 13%,the specificity was 65. 38%; these of p H were 0. 712,7. 05,90. 63% and 96. 15%,respectively; these of BE were 0. 627,- 15. 23 mmol / L,78. 13% and 88. 46%,respectively. Conclusion Compared with Apgar score along,the p H and BE of umbilical artery blood could evaluate multiple organ damage after neonatal asphyxia more accurately,which would help increase the accuracy rate of diagnosis.